Nonprofit Resume Samples - Excel

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					          Pennsylvania Council on the Arts                                                         PCA USE ONLY
          Council Initiated Projects: Arts In Education                                       Apply application label here
          Teacher Artists Partnerships & Long-Term Residencies
          Postmark Deadline: January 31, 2011                                                                                        33-K-430

A. Organization Information
 A1 Name of Organization:
 A2 Name of Parent Organization (if any):
 A3       Federal ID/SSN #:
 A4       Address, Line 1:
 A5       Address, Line 2:
 A6       City, State, Zip + 4:
 A7       County:
 A8       Phone #:
 A9       Alternate Phone #:
A10       Fax #:
A11       Web Address (URL):
A12       Contact Person:
A13       Email Address:
A14       PA House District #:
A15       PA Senate District #
A16       U.S. Congressional District #:

Certification and Statement of Assurances
 The applicant certifies, represents and warrants to the Council that it meets all eligibility requirements set forth by the Council, including
 its status as a nonprofit corporation pursuant to IRS Section 501(c) and that:

 1. The information contained herein and in all attachments and supporting material is true and correct, the filing of the application has
 been duly authorized by the governing body of the applicant, and the undersigned have authority to execute this application on behalf of
 the applicant.

 2. The applicant accepts in advance any grant awarded by the Council, agreeing: a.) That any funds received as a result of the
 application will be expended solely for the described projects and programs, in accordance with the provisions of the "Additional Terms
 and Conditions Governing Grants-in-Aid" and "General Provisions." b.) To such other restrictions, conditions, and changes as the
 Council may impose, unless the applicant objects within 30 days of mailing of the award letter setting forth the terms of the grant in
 writing.

 3. Any organization that the applicant assists will also comply with the provisions of the "Additional Terms and Conditions Governing
 Grants-in-Aid" and "General Provisions," when conducting any activity for which the applicant receives financial assistance from the
 Council.

 4. All participating artists will meet Act 34 and CPSL clearance requirements, required to work in public and private school settings in
 Pennsylvania at the time of residency.




           Signatures Must Be ORIGINAL (Not Photocopied) On each Copy of the Application USE BLUE INK




           Sponsor Official, Date                           Project Director, Date                               Artist, Date


           Typed Name & Title                              Typed Name & Title                              Typed Name & Title

2011-2012                                                                                              Pennsylvania Council on the Arts
        Pennsylvania Council on the Arts
        Council Initiated Projects: Arts In Education
        Teacher Artists Partnerships & Long-Term Residencies
        Organization/Subsidiary Name:

B. Artist Information
 B1 Artist Name:
 B2     Artist Federal ID/SSN #:
 B3     Artist Address, Line 1:
 B4     Artist Address, Line 2:
 B5     Artist City, State, Zip + 4:
 B6     Artist County:
 B7     Artist Phone #:
 B8     Artist Fax #:
 B9     Artist Email Address:
B10     Artist Web Address (URL):


C. Project Information
 C1 Grant Category (check one):          Teacher Artist Partnership (TAP)         Long-Term Residency (LTR)
 C2 Project Start Date (Month/Year; 00/0000):
 C3 Project Length (number of residency/planning days. Minimum of 60 days or equivalent):
 C4 Are you a returning school/organization funded in 2010-2011?            Yes            No
       a. If previously funded, indicate by program and by year:   2008-2009        2009-2010      2010-2011
                                                           TAP:
                                                           LTR:
 C5 Will there be a Visiting Artist?        Yes          No
 C6 Primary discipline of proposed project (Check only ONE):
         01 Dance                           06 Design Arts                  11 Interdisciplinary
         02 Music                           07 Crafts                       12 Folk Arts
         03 Opera/Musical Theater           08 Photography                  14 Multidisciplinary
         04 Theater                         09 Media Arts
         05 Visual Arts                     10 Literature

      a. If you checked # 12 Folk Arts or #14 Multi-Disciplinary check below ALL those that apply:
         01 Dance                           05 Visual Arts                  09 Media Arts
         02 Music                           06 Design Arts                  10 Literature
         03 Opera/Musical Theater           07 Crafts                       11 Interdisciplinary
         04 Theater                         08 Photography

 C7 City/Town Population:                a. Check One:                 b. Check One:
                                            Under 10,000                   Urban
                                             10,000 to 50,000              Suburban
                                             50,001 to 250,000              Rural
                                            Over 250,000


2011-2012                                                                    Pennsylvania Council on the Arts
        Pennsylvania Council on the Arts
       Council Initiated Projects: Arts In Education
       Teacher Artists Partnerships & Long-Term Residencies
       Organization/Subsidiary Name:

C. Project Information (continued)
 C9 Project Summary (50 words or less):
    Note: If funded, this summary will be published in the report to the Council.




D. Host Organization Information
 D1 Host Organization Name:
 D2    Host Federal ID/SSN #:
 D3    Host Address, Line 1:
 D4    Host Address, Line 2:
 D5    Host City, State, Zip + 4:
 D6    Host County:
 D7    Host Phone #:
 D8    Host Alternate Phone #:
 D9    Host Fax #:
D10    Host Web Address (URL):
D11    Director/Chief Administrative Officer:
D12    Director Email Address:
D13 Type of Host (check only One):
         03 Performing Group                    27 Library
         08 Art Museum                          30 Foundation
         15 Art Center                          32 Community Service Organization
         16 Arts Council/Agency                 32 Correctional Institution: Adult       Youth
         17 Arts Service Organization           34 Health Care Facility
         19 School District                     35 Religious Organization
         21 School - Elementary                 36 Senior Citizen's Center
         22 School - Middle                     37 Parks & Recreation
         23 School - Secondary                  48 School of the Arts
         26 College/University                  25 Other School (Pre-K)
         99 None of the Above (Describe):

2011-2012                                                                    Pennsylvania Council on the Arts
       Pennsylvania Council on the Arts
       Council Initiated Projects: Arts In Education
       Teacher Artists Partnerships & Long-Term Residencies
       Organization/Subsidiary Name:

D. Host Organization Information (continued)
D14 Check where appropriate if Host is part of:         City Government            County Government
D15 Project Director Name:
D16    Project Director Address, Line 1:
D17    Project Director Address, Line 2:
D18    Project Director City, State, Zip + 4:
D19    Project Director Phone #:
D20    Project Director Email Address:
D21 Estimated # Hours/Week Project Director will devote to Project/Residency:
D22 Project Director's relationship to Host Organization:
         01 Director of Host Organization         05 Counselor/Teacher
         02 Principal                             06 Other Staff (Specify:)
         03 Program Manager                       07 Volunteer (Specify:)
         04 Other Administrator

D23 Project Site (if different from Host or Sponsor address):
D24    Host Site Address, Line 1:
D25    Host Site Address, Line 2:
D26    Host Site City, State, Zip + 4:
D27    Host Site Phone #:

E. Co-Sponsorship
 E1 Will project be co-sponsored?                    Yes           No
      COMPLETE AND SUBMIT THE FOLLOWING SECTION ONLY IF THE PROJECT IS CO-SPONSORED


 E2 Co-Sponsor Organization Name:
 E3    Co-Sponsor Federal ID/SSN #:
 E4    Co-Sponsor Address, Line 1:
 E5    Co-Sponsor Address, Line 2:
 E6    Co-Sponsor City, State, Zip + 4:
 E7    Co-Sponsor County:
 E8    Co-Sponsor Phone #:
 E9    Co-Sponsor Alternate Phone #:
E10    Co-Sponsor Fax #:
E11    Co-Sponsor Web Address (URL):



2011-2012                                                                     Pennsylvania Council on the Arts
       Pennsylvania Council on the Arts
       Council Initiated Projects: Arts In Education
       Teacher Artists Partnerships & Long-Term Residencies
       Organization/Subsidiary Name:

E. Co-Sponsorship (continued)
E12 Director/Chief Administrative Officer:
E13 Email Address:
E14 Type of Co-Sponsor (check only One):
        03 Performing Group                    27 Library
        08 Art Museum                          30 Foundation
        15 Art Center                          32 Community Service Organization
        16 Arts Council/Agency                 32 Correctional Institution:       Adult      Youth
        17 Arts Service Organization           34 Health Care Facility
        19 School District                     35 Religious Organization
        21 School - Elementary                 36 Senior Citizen's Center
        22 School - Middle                     37 Parks & Recreation
        23 School - Secondary                  48 School of the Arts
        26 College/University                  25 Other School (Pre-K)
        99 None of the Above (Describe):

E15 Check where appropriate if Co-Sponsor is part of:          City Government             County Government
E16 Co-Sponsor Contact Name:
E17    Co-Sponsor Contact Address, Line 1
E18    Co-Sponsor Contact Address, Line 2
E19    Co-Sponsor Contact City, State, Zip +4
E20    Co-Sponsor Contact Phone #:
E21    Co-Sponsor Contact Email Address:

                                   Agreement to Co-Sponsor
      Host Name:
       will be responsible for project costs as follows:
                                                          Artist Fess (Total):
                                              Project Supplies and Materials:
                                                        Other Project Costs:

      Co-Sponsor Name:
       will be responsible for project costs as follows:
                                                          Artist Fess (Total):
                                              Project Supplies and Materials:
                                                        Other Project Costs:




2011-2012                                                                        Pennsylvania Council on the Arts
       Pennsylvania Council on the Arts
       Council Initiated Projects: Arts In Education
       Teacher Artists Partnerships & Long-Term Residencies
       Organization/Subsidiary Name:

F. Artist's Resume and Work Samples
 Submit a current resume, covering all relevant professional artist and teaching activity and
 achievements. List activities in chronological order beginning with the most recent. Include dates of all
 activities as this determines your eligibility. Use 12 point type or larger. Do not exceed two 8½” x 11”
 single-sided pages. (Number the pages F1, F2, etc.)

 You must also submit work samples (no more than three years old) that correspond to the discipline of
 the proposed project. Please include a brief description of the work(s) and any particular instructions on
 viewing or listening to the submissions.


G. Project Narrative
 Question 1 and 2 are to be answered by the artist.

 Question 3 is to be answered by the host organization.

 Refer to the Review Criteria as you formulate your responses. Precede each response with the section
 heading (e.g. 1. Artist’s Statement). Type applicant artist’s name in upper left corner of each page.
 Number the pages G1, G2, G3, with a collaborating artist: G1 to G4. Do not exceed page limits.

 G1. ARTIST'S STATEMENT
   Using up to one page, briefly address the following: (a) Describe your work and development as an
   artist; (b) Why do you want to be a teaching artist in the program?; (c) Who are your target
   participants and what qualifies you to work with them?

    If you are a continuing artist(s) applying for a subsequent year of TAP/LTR funding, briefly address
    the following: (d) Describe how the residency has affected you and your work; (e) Describe your own
    professional growth as an artist in the last year.

 G2. PROJECT DESCRIPTION
   Using up to one page, briefly address the following: (a) What do you hope to accomplish with your
   project/residency? What Skills/knowledge will participants gain?; (b) Breifly describe a typical
   session; (c) Briefly describe what activities will occur during a sample week; How will the project use
   the existing resources of the sponsor and the community?; If you plan to use Visiting Artist(s),
   describe their involvement, including the names of the artist(s).

    If you are a continuing artist: (d) Describe the effects your project/residency has had on your
    participants; (e) How will the project build on the previous year's experiences?; (f) What changes
    have been or will be made?; (g) Will the project serve the same people and/or take place at the
    same sites?

 G3. HOST STATEMENT
    Must be written by the host site. A letter of support from the host confirming the match and their
    commitment to participate must accompany the application as well.

    Using up to one page, briefly address the following: (a) Describe the host school/organization's
    purpose. What are the regular ongoing art programs and services of the host? <continued.>




2011-2012                                                                    Pennsylvania Council on the Arts
         Pennsylvania Council on the Arts
        Council Initiated Projects: Arts In Education
        Teacher Artists Partnerships & Long-Term Residencies
        Organization/Subsidiary Name:

G. Project Narrative
      <continued> (b) How does the proposed project differ from the regular programs and services?;
      (c) How was the need for this project/residency established? Describe the demographics of the
      population to be served. What are their needs and how will this project serve those needs? (d)
      Discuss the impact of the project/residency on the participants and the site; (e) How will you reach
      your targeted populations? (f) If applicatiple, how will participants be recruited for this project? (g)
      Describe the facilities in which the project/residency activities will take place; (h) Describe your
      reasons for selecting this artist(s) to work with.

      If there will be a co-sponsoring organization(s): (a) Describe the co-sponsor organization's
      purpose; (b) What is the co-sponsor's role in the project?; (c) How will the organizations work
      together?



H. Project Information
      Residency schedules are a combination of session hours and preparation time.
      Preparation includes set-up, clean-up, and meetings with your Project Director.
      The average ratio is approximately 15 hours of session time to 5 hours of preparation time. If your
      schedule varies from this, attach an explanation.

 H1 How many hours per week (on average) will you spend working with
    participants in session activities?                                                              hours
 H2 How many hours per week (on average) will you spend in
    preparation time?                                                                                hours
 H3                                                 Total Hours (should = 20):                       hours

 H4 Length of residency?                            # Days:                        = # Weeks:
 H5 Total direct participants over the course of the residency?
 H6 Total indirect participants over the course of the residency
    (i.e. audience, community)?
 H7 What is the age range of the participants?                             to                        years old
H8    Provide a demographic description of your participants in 50 words or less
      (age, ethnicity, income level, education, occupation, etc.)




2011-2012                                                                        Pennsylvania Council on the Arts
      Pennsylvania Council on the Arts
      Council Initiated Projects: Arts In Education
      Teacher Artists Partnerships & Long-Term Residencies
      Organization/Subsidiary Name:

I. Schedule of Activities
 Duplicate this page as needed.

 Indicate the ACTUAL weekly schedule devised by your team. Include the following: 1) Session time and
 location; 2) Number of participants and age range; 3) Preparation time; 4) Meeting time with project
 director; 5) Number groups to identify classes that meet more than once a week. (TAP teams will submit
 their schedule after they have an approved plan).


       Monday            Tuesday          Wednesday         Thursday      Friday           Saturday      Sunday

      #1: 9-11 AM                          #1: 9-11 AM                  #1: 9-11 AM
      Mr. Smith's                          Mr. Smith's                  Mr. Smith's
         Class                                Class                        Class
      10 Students                          10 Students                  10 Students       #3 1 -4 PM
       14-16 yrs                            14-16 yrs                    14-16 yrs        Mrs. Black's
                          Meet with                                                          Class
      12-1 PM Prep     Project Director   12-1 PM Prep                 12-1 PM Prep       12 Students
                           1-2 PM                                                          12-13 yrs
     #2: 1 - 3:30 PM                      #2: 1 - 3:30 PM              #2: 1 - 3:30 PM
      Mrs. Jones'                          Mrs. Jones'                  Mrs. Jones'      10-11 AM Prep
          Class                                Class                        Class
       8 Students                           8 Students                   8 Students
        12-13 yrs                            12-13 yrs                    12-13 yrs



       Monday            Tuesday          Wednesday         Thursday      Friday           Saturday      Sunday




2011-2012                                                                         Pennsylvania Council on the Arts
        Pennsylvania Council on the Arts
        Council Initiated Projects: Arts In Education
        Teacher Artists Partnerships & Long-Term Residencies
        Organization/Subsidiary Name:

J. Project Income
      Applicant Match (refer to corresponding requirements)                                       Confirm         Amount
 J1                                                                                                                        $0.00
 J2                                                                                                                        $0.00
 J3                                                                                                                        $0.00
 J4                                                                                                                        $0.00
 J5                                                                                                                        $0.00
 J6                                                                                                                        $0.00
 J7                                                                                                                        $0.00
 J8                                                                    Amount Requested from PCA:                          $0.00
 J9                                                                                       Total Revenue:                   $0.00

K. Project Expenses: Artist Fees                                (for resident and visiting artists)

                                                                             Fees Per            Expenses
      Artist(s) Names                                        # Days                                               Amount
                                                                                Day               per Day
 K1                                                             0                     $0.00           $0.00                $0.00
 K2                                                             0                     $0.00           $0.00                $0.00
 K3                                                             0                     $0.00           $0.00                $0.00
 K4                                                             0                     $0.00           $0.00                $0.00
 K5                                                             0                     $0.00           $0.00                $0.00
 K6                                                             0                     $0.00           $0.00                $0.00
 K7                                                             0                     $0.00           $0.00                $0.00
 K8                                                                                    Total Artist Fees:                  $0.00
      Note: Travel expenses are limited to: Lodging and meals, not to exceed $80 per day; and current Federal Standard
      milage rate, or in lieu of milage, the cost of public transportation, whichever is less.

L. Project Expenses: Supplies, Administration, and Others
      Description                                                                                                 Amount
 L1                                                                                                                        $0.00
 L2                                                                                                                        $0.00
 L3                                                                                                                        $0.00
 L4                                                                                                                        $0.00
 L5                                                                                                                        $0.00
 L6                                                                                                                        $0.00
 L7                                                                                                                        $0.00
 L8                                                              Total Supplies/Admin Expenses:                            $0.00
 L9                        TOTAL EXPENSES (Total Artist Fees + Total Supplies/Admin):                                      $0.00

2011-2012                                                                                           Pennsylvania Council on the Arts
      Pennsylvania Council on the Arts
      Council Initiated Projects: Arts In Education
      Teacher Artists Partnerships & Long-Term Residencies
      Postmark Deadline: January 31, 2011

      Organization/Subsidiary Name:

TAP & LTR Application Package Assembly Checklist
    Check and provide single-sided and collated copies of the follow pages

    Note: Please do not staple sets of application pages. Use paperclips to bind forms.

    1 copy                1. TAP & LTR Application Checklist (this page)

                               AND
    3 copies              2. TAP & LTR Application Form (Pages 1-9)

                               AND
    1 copy                3. IRS Determination Letter confirming nonprofit 501(c) status.
                             (from arts organization or school district)

                               AND
    1 copy                4. Supplemental Materials & Work Samples
                             Supplemetal materials and work samples will be made available
                             to panelists at the time of the panel review

                               AND
       1                  5. Self-addressed stamped envelope
                             suitable for the return of your work samples


             ALL copies of the application MUST have ORIGINAL Signatures in BLUE INK only




    Assemble the application package as illustrated below:

       1              2              3    on top of   4                             5



     1 copy       3 copies       1 copy           1 copy each      1 copy         1 Self-
      this       TAP& LTR       IRS Tax          Supplemental       Work        Addressed
    checklist    application    Exempt             Materials      Samples        Stamped
                                 Letter                                         Envelope


                               MAIL TO:     ATTN: Marcella Shoffner
                                            Pennsylvania Council on the Arts
                                            216 Finance Building
                                            Harrisburg, PA 17120




2011-2012                                                                         Pennsylvania Council on the Arts

				
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