Council for the Arts Grants Program

Council for the Arts at MIT
Grants Program
Application Form

Please read the Grants Program Guidelines before completing this application form and guidelines checklist. All sections must be completed. If you have any questions, please call 617/253-4005 or send e-mail to cohen@media.mit.edu.

Applicant and project information

First name*

Middle initial

Last name*

MIT email*

Phone number*
(nnn-nnn-nnnn)

Group name*

MIT affiliation*

MIT address*

Project title*

Project location*

Faculty advisor*

Project start date*
(mm/dd/yyyy)

Project end date*
(mm/dd/yyyy)

Itemized expenses

The amount you are requesting from the Council for the Arts and the amount requested from other sources should add up to the total cost for the itemized expenses. If cash or in-kind contributions are not yet approved, please indicate with an asterisk (*) next to the source.

Project expenses	Amount requested from Council for the Arts	Cash contributions	In-kind contributions
type (materials/equipment/fees/etc.)	total amount	source	amount	source	amount
1.		$	$		$		$
2.		$	$		$		$
3.		$	$		$		$
4.		$	$		$		$
5.		$	$		$		$
6.		$	$		$		$
7.		$	$		$		$
8.		$	$		$		$
9.		$	$		$		$
10.		$	$		$		$
11.		$	$		$		$
12.		$	$		$		$
13.		$	$		$		$
14.		$	$		$		$
15.		$	$		$		$
16.		$	$		$		$
17.		$	$		$		$
18.		$	$		$		$
19.		$	$		$		$
20.		$	$		$		$
21.		$	$		$		$
22.		$	$		$		$
23.		$	$		$		$
24.		$	$		$		$
25.		$	$		$		$

Total	$	$		$		$

Project expenses

Amount requested from Council for the Arts

Cash contributions

In-kind contributions

type (materials/equipment/fees/etc.)

total amount

source

amount

source

amount

10.

Total

Total cost: $

Total amount requested from the Council for the Arts: $

Total amount requested from other sources: $

Checklist

Please check off the following items to indicate that you have read and agree to them:

I have read the Grants Program guidelines and understand the application review procedures.

The budget prepared above represents a current assessment of project expenses and contributions. Within one month of the project's completion, I will submit to the Council for the Arts a final report and financial statement, including copies of receipts equal to the grant amount.

I agree to provide supporting material by the deadline date of the funding cycle. Certain kinds of supporting material will be photocopied for advance distribution to Grants Committee members. I will also provide other material for the "site visit" with Grants Committee members.

I agree to be available from 9:00-11:00 am for a scheduled site visit on the review date of the funding cycle. If this is not possible, I will notify the Council staff 2 weeks in advance of the review date. The Council staff may arrange another appointment.

I understand that the Council for the Arts reserves the right to describe or reproduce material from any project awarded funding through its Grants Program for publication or public relations purposes.

Council for the Arts at MIT Grants Program Application Form

Applicant and project information

Project information

Itemized expenses

Checklist

Council for the Arts at MIT
Grants Program
Application Form