Massachusetts Cultural Council | LCC Grant Application

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	.

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

About the MCC | Grant Programs & Services | News
copyright 1999 the Massachusetts Cultural Council