Due October 15, 1999 to Local Cultural Councils.
Please fill out this form, print it, sign it and mail to the appropriate local cultural council.
Do not mail to the MCC.
If this is a
local cultural council-originated request
or a
capital expenditure request
, you must answer additional questions found on the appropriate Supplemental Questions Form.
This application is being submitted to the
Please Select
Abington Cultural Council
Acton-Boxborough Cultural Council
Acushnet Cultural Council
Agawam Cultural Council
Alford-Egremont Cultural Council
Amesbury Cultural Council
Amherst Cultural Council
Andover Cultural Council
Aquinnah Cultural Council
Arlington Cultural Council
Ashburnham Cultural Council
Ashby Cultural Council
Ashfield Cultural Council
Ashland Cultural Council
Athol Cultural Council
Attleborough Cultural Council
Auburn Cultural Council
Avon Cultural Council
Ayer Cultural Council
Barnstable Cultural Council
Barre Cultural Council
Becket Cultural Council
Bedford Cultural Council
Belchertown Cultural Council
Bellingham Cultural Council
Belmont Cultural Council
Berkley Cultural Council
Berlin Cultural Council
Bernardston Cultural Council
Beverly Cultural Council
Billerica Cultural Council
Blackstone Cultural Council
Blandford Cultural Council
Bolton Cultural Council
Boston Cultural Council
Bourne Cultural Council
Boxford Cultural Council
Boylston Cultural Council
Braintree Cultural Council
Brewster Cultural Council
Bridgewater Cultural Council
Brimfield Cultural Council
Brockton Cultural Council
Brookfield Cultural Council
Brookline Cultural Council
Buckland Cultural Council
Burlington Cultural Council
Cambridge Cultural Council
Canton Cultural Council
Carlisle Cultural Council
Carver Cultural Council
Charlemont-Hawley Cultural Council
Charlton Cultural Council
Chatham Cultural Council
Chelmsford Cultural Council
Chelsea Cultural Council
Chester Cultural Council
Chesterfield Cultural Council
Chicopee Cultural Council
Chilmark Cultural Council
Clinton Cultural Council
Cohasset Cultural Council
Colrain Cultural Council
Concord Cultural Council
Conway Cultural Council
Cummington Cultural Council
Dalton Cultural Council
Danvers Cultural Council
Dartmouth Cultural Council
Dedham Cultural Council
Deerfield Cultural Council
Dennis Cultural Council
Dighton Cultural Council
Douglas Cultural Council
Dover Cultural Council
Dracut Cultural Council
Dudley Cultural Council
Dunstable Cultural Council
Duxbury Cultural Council
East Bridgewater Cultural Council
East Brookfield Cultural Council
East Longmeadow Cultural Council
Eastham Cultural Council
Easthampton Cultural Council
Easton Cultural Council
Edgartown Cultural Council
Erving Cultural Council
Essex Cultural Council
Everett Cultural Council
Fairhaven Cultural Council
Fall River Cultural Council
Falmouth Cultural Council
Fitchburg Cultural Council
Foxborough Cultural Council
Framingham Cultural Council
Franklin Cultural Council
Freetown Cultural Council
Gardner Cultural Council
Georgetown Cultural Council
Gill Cultural Council
Gloucester Cultural Council
Goshen Cultural Council
Gosnold Cultural Council
Grafton Cultural Council
Granby Cultural Council
Granville Cultural Council
Great Barrington Cultural Council
Greenfield Cultural Council
Groton Cultural Council
Groveland Cultural Council
Hadley Cultural Council
Halifax Cultural Council
Hamilton-Wenham Cultural Council
Hampden Cultural Council
Hanover Cultural Council
Hanson Cultural Council
Hardwick-New Braintree Cultural Council
Harvard Cultural Council
Harwich Cultural Council
Hatfield Cultural Council
Haverhill Cultural Council
Heath Cultural Council
Hingham Cultural Council
Hinsdale-Peru Cultural Council
Holbrook Cultural Council
Holden Cultural Council
Holland Cultural Council
Holliston Cultural Council
Holyoke Cultural Council
Hopedale Cultural Council
Hopkinton Cultural Council
Hubbardston Cultural Council
Hudson Cultural Council
Hull Cultural Council
Huntington Cultural Council
Ipswich Cultural Council
Kingston Cultural Council
Lakeville Cultural Council
Lancaster Cultural Council
Lawrence Cultural Council
Lee Cultural Council
Leicester Cultural Council
Lenox Cultural Council
Leominster Cultural Council
Leverett Cultural Council
Lexington Cultural Council
Leyden Cultural Council
Lincoln Cultural Council
Littleton Cultural Council
Longmeadow Cultural Council
Lowell Cultural Council
Ludlow Cultural Council
Lunenburg Cultural Council
Lynn Cultural Council
Lynnfield Cultural Council
Malden Cultural Council
Manchester Cultural Council
Mansfield Cultural Council
Marblehead Cultural Council
Marion Cultural Council
Marlborough Cultural Council
Marshfield Cultural Council
Mashpee Cultural Council
Mattapoisett Cultural Council
Maynard Cultural Council
Medfield Cultural Council
Medford Cultural Council
Medway Cultural Council
Melrose Cultural Council
Mendon Cultural Council
Merrimac Cultural Council
Methuen Cultural Council
Middleborough Cultural Council
Middlefield Cultural Council
Middleton Cultural Council
Milford Cultural Council
Millbury Cultural Council
Millis Cultural Council
Millville Cultural Council
Milton Cultural Council
Monson Cultural Council
Montague Cultural Council
Monterey Cultural Council
Montgomery Cultural Council
Mount Washington Cultural Council
Nahant Cultural Council
Nantucket Cultural Council
Natick Cultural Council
Needham Cultural Council
New Bedford Cultural Council
New Marlborough Cultural Council
New Salem Cultural Council
Newbury Cultural Council
Newburyport Cultural Council
Newton Cultural Council
Norfolk Cultural Council
North Andover Cultural Council
North Attleborough Cultural Council
North Brookfield Cultural Council
North Reading Cultural Council
Northampton Cultural Council
Northborough Cultural Council
Northbridge Cultural Council
Northern Berkshire Cultural Council
Northfield Cultural Council
Norton Cultural Council
Norwell Cultural Council
Norwood Cultural Council
Oak Bluffs Cultural Council
Oakham Cultural Council
Orange Cultural Council
Orleans Cultural Council
Otis Cultural Council
Oxford Cultural Council
Palmer Cultural Council
Paxton Cultural Council
Peabody Cultural Council
Pelham Cultural Council
Pembroke Cultural Council
Pepperell Cultural Council
Petersham Cultural Council
Phillipston Cultural Council
Pittsfield Cultural Council
Plainfield Cultural Council
Plainville Cultural Council
Plymouth Cultural Council
Plympton Cultural Council
Princeton Cultural Council
Provincetown Cultural Council
Quincy Cultural Council
Randolph Cultural Council
Raynham Cultural Council
Reading Cultural Council
Rehoboth Cultural Council
Revere Cultural Council
Richmond Cultural Council
Rochester Cultural Council
Rockland Cultural Council
Rockport Cultural Council
Rowe Cultural Council
Rowley Cultural Council
Royalston Cultural Council
Russell Cultural Council
Rutland Cultural Council
Salem Cultural Council
Salisbury Cultural Council
Sandisfield Cultural Council
Sandwich Cultural Council
Saugus Cultural Council
Scituate Cultural Council
Seekonk Cultural Council
Sharon Cultural Council
Sheffield Cultural Council
Shelburne Cultural Council
Sherborn Cultural Council
Shirley Cultural Council
Shrewsbury Cultural Council
Shutesbury Cultural Council
Somerset Cultural Council
Somerville Cultural Council
South Hadley Cultural Council
Southampton Cultural Council
Southborough Cultural Council
Southbridge Cultural Council
Southwick Cultural Council
Spencer Cultural Council
Springfield Cultural Council
Sterling Cultural Council
Stockbridge Cultural Council
Stoneham Cultural Council
Stoughton Cultural Council
Stow Cultural Council
Sturbridge Cultural Council
Sudbury Cultural Council
Sunderland Cultural Council
Sutton Cultural Council
Swampscott Cultural Council
Swansea Cultural Council
Taunton Cultural Council
Templeton Cultural Council
Tewksbury Cultural Council
Tisbury Cultural Council
Tolland Cultural Council
Topsfield Cultural Council
Townsend Cultural Council
Truro Cultural Council
Tyngsborough Cultural Council
Tyringham Cultural Council
Upton Cultural Council
Uxbridge Cultural Council
Wakefield Cultural Council
Wales Cultural Council
Walpole Cultural Council
Waltham Cultural Council
Ware Cultural Council
Wareham Cultural Council
Warren Cultural Council
Warwick Cultural Council
Washington Cultural Council
Watertown Cultural Council
Wayland Cultural Council
Webster Cultural Council
Wellesley Cultural Council
Wellfleet Cultural Council
Wendell Cultural Council
West Boylston Cultural Council
West Bridgewater Cultural Council
West Brookfield Cultural Council
West Newbury Cultural Council
West Springfield Cultural Council
West Stockbridge Cultural Council
West Tisbury Cultural Council
Westborough Cultural Council
Westfield Cultural Council
Westford Cultural Council
Westhampton Cultural Council
Westminster Cultural Council
Weston Cultural Council
Westport Cultural Council
Westwood Cultural Council
Weymouth Cultural Council
Whately Cultural Council
Whitman Cultural Council
Wilbraham Cultural Council
Williamsburg Cultural Council
Wilmington Cultural Council
Winchendon Cultural Council
Winchester Cultural Council
Windsor Cultural Council
Winthrop Cultural Council
Woburn Cultural Council
Worcester Cultural Council
Worthington Cultural Council
Wrentham Cultural Council
Yarmouth Cultural Council
.
APPLICANT INFORMATION
Federal Employee ID No./ Social Security No:
Applicant's Name:
Address:
City:
, MA Zip:
Applicant Phone:
Contact Person:
Contact Address:
Contact City:
, MA Zip:
Contact Phone:
Give the number of people from each category who will benefit from this project:
CHILDREN
ADULTS
PROJECT INFORMATION
Project Description:
Amount Requested from LCC $
Each of the boxes below will allow more to be typed in them than will actually print. If you wish to provide more information than will fit in the prescribed space, please attach an additional typed page.
1. Summarize the proposed project in the space provided. (Describe who is the target audience; what will happen; when and where it will occur; and how the project will be executed. While you may provide additional narrative on a separate sheet of paper, you must summarize the project here.) [This form will only print the first 10 lines of what is typed in the box below. If you need more space, please attach an additional page.]
2. Describe the planning done for this project in terms of process, and who or what organizations was/were involved as partners or advisors. [This form will only print the first 6 lines of what is typed in the box below. If you need more space, please attach an additional page.]
3. Explain how this project will reach and benefit the citizens of this community. How will you know the project is successful? (Include promotion, expected results and plans for evaluation.) [This form will only print the first 6 lines of what is typed in the box below. If you need more space, please attach an additional page.]
4. Please detail the qualifications of key artists, humanists, interpretive scientists or organizations involved with leading the cultural component of this project.
Application will be considered incomplete without this information.
(Please attach resumes.) [This form will only print the first 6 lines of what is typed in the box below. If you need more space, please attach an additional page.]
BUDGET INFORMATION
Total Project Cost:
$
Matching Funds*:
$
Source of Matching Funds:
*
Capital expenditures
must have a 2:1 match. Check with the local cultural council to see if there are any additional match requirements.
PROJECT EXPENSES
A. Salaries/Fees
Artist/Humanist/Interpretive Scientist
$
Administrative
$
Other (Specify)
$
TOTAL Section A
$
B. Space Rental
$
C. Travel
$
D. Marketing
$
E. Remaining Project Expenses
1. Equipment Rental
$
2. Project supplies or consumables
$
3. Printing
$
4. Shipping/Postage
$
5. Utilities/Telephone
$
6. Insurance
$
7. Other (Specify)
$
8. Ensuring Access
$
TOTAL Section E
$
F.
Capital Expenditures
$
G. TOTAL PROJECT EXPENSES*
(Sum of Totals in Sections A - F)
$
* NOTE:
Total Project Expenses and Total Project Revenue must be equal.
PROJECT INCOME
A. Earned Income
$
B. Non-Government
1. Corporate/Business
$
2. Clubs and Organizations
$
3. Other (Specify)
$
TOTAL Section B
$
C. Government
1. Total requested from other LCCs for this project: (attach a seperate sheet specifying the LCCs and $ amounts)
$
2. Other MCC Programs
$
3. Other (Municipal, School, etc.)
$
TOTAL Section C
$
D. Applicant Cash
$
E. Amount Requested from this LCC
$
F.
In-Kind Contributions
(donated space, materials and/or services)
$
G. TOTAL PROJECT REVENUE*
(Sum of Totals in Sections A - F)
$
*NOTE:
Total Project Expenses and Total Project Revenue must be equal.
Authorized Signatures:
The signature below is that of the person authorized to testify as to the accuracy of this application and the person who agrees that the required acknowledgement will be given to the Massachusetts Cultural Council and the granting local cultural council, if this application is approved.
Please fill out this form, print it, sign it and mail to the appropriate local cultural council.
Do not mail to the MCC.
Signature
Title
Date
FOR LOCAL/REGIONAL CULTURAL COUNCIL USE ONLY
Amount Approved
Signature of LCC Chair or
Authorized LCC Member
Title
Date
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