(cid:49)(cid:82)(cid:87)(cid:72)(cid:3)(cid:87)(cid:82)(cid:3)(cid:48)(cid:68)(cid:70)(cid:3)(cid:56)(cid:86)(cid:72)(cid:85)(cid:86)(cid:29)(cid:3)(cid:51)(cid:79)(cid:72)(cid:68)(cid:86)(cid:72)(cid:3)(cid:70)(cid:82)(cid:80)(cid:83)(cid:79)(cid:72)(cid:87)(cid:72)(cid:3)(cid:87)(cid:75)(cid:76)(cid:86)(cid:3)(cid:73)(cid:82)(cid:85)(cid:80)(cid:3)(cid:76)(cid:81)(cid:3)(cid:36)(cid:71)(cid:82)(cid:69)(cid:72)(cid:3)(cid:53)(cid:72)(cid:68)(cid:71)(cid:72)(cid:85)(cid:3)(cid:82)(cid:85)(cid:3)(cid:36)(cid:70)(cid:85)(cid:82)(cid:69)(cid:68)(cid:87)(cid:17)(cid:3)(cid:38)(cid:82)(cid:80)(cid:83)(cid:79)(cid:72)(cid:87)(cid:76)(cid:81)(cid:74)(cid:3)(cid:87)(cid:75)(cid:76)(cid:86)(cid:3)(cid:73)(cid:82)(cid:85)(cid:80)(cid:3)(cid:76)(cid:81)(cid:3)(cid:3)(cid:48)(cid:68)(cid:70)(cid:3)(cid:51)(cid:85)(cid:72)(cid:89)(cid:76)(cid:72)(cid:90)(cid:3)(cid:80)(cid:68)(cid:92)(cid:3)(cid:70)(cid:68)(cid:88)(cid:86)(cid:72)(cid:3)(cid:70)(cid:82)(cid:80)(cid:83)(cid:68)(cid:87)(cid:68)(cid:69)(cid:76)(cid:79)(cid:76)(cid:87)(cid:92)(cid:3)(cid:76)(cid:86)(cid:86)(cid:88)(cid:72)(cid:86)(cid:17) FY 2019(cid:3)Sponsored Organization Information Form - New York State Council on the Arts - Basic Organization(cid:68)(cid:79) Information Organization Name AKA Federal Employer ID# Year Founded Web Site(URL) Organization's Phone Address1 Address2 City State Zip Applicant County Project Contact Name Title Phone Fax Email Address Organization Mission (1000 character limit) Organization Activities (1000 character limit) Activities: Give a brief summary of your organization's activities that provides a general overview of what you do as an organization. Please relate these activities to your mission statement in the previous question. Organization Constituency (1000 character limit) Given your mission to the community you serve, how does your organization address diversity and inclusiveness? What actions has your organization taken tomake your facilities, programs, and(cid:18)(cid:82)(cid:85) communications systems accessible and usable by all? Briefly describe your facilities(cid:15)(cid:3)(cid:76)(cid:73)(cid:3)(cid:68)(cid:81)(cid:92). Explain any relocations, expansions, renovations, ormajor improvements undertakenin the recent past or planned for the future. Organization Facilities(cid:3)(cid:11)(cid:76)(cid:73)(cid:3)(cid:68)(cid:83)(cid:83)(cid:79)(cid:76)(cid:70)(cid:68)(cid:69)(cid:79)(cid:72)(cid:12) Organization's facilities/real estate are: Owned Rented Donated Shared If rented, date current lease expires? Days/Hours/Season of Operation Please indicate the number of each event your organizations hosts annually. Enter zero if your organization does not host a particular event: (cid:51)(cid:85)(cid:82)(cid:71)(cid:88)(cid:70)(cid:87)(cid:76)(cid:82)(cid:81)(cid:86)(cid:3) (cid:40)(cid:91)(cid:75)(cid:76)(cid:69)(cid:76)(cid:87)(cid:76)(cid:82)(cid:81)(cid:86) (cid:38)(cid:79)(cid:68)(cid:86)(cid:86)(cid:72)(cid:86) (cid:55)(cid:82)(cid:88)(cid:85)(cid:86) (cid:41)(cid:76)(cid:79)(cid:80)(cid:86) (cid:47)(cid:72)(cid:70)(cid:87)(cid:88)(cid:85)(cid:72)(cid:86) (cid:51)(cid:72)(cid:85)(cid:73)(cid:82)(cid:85)(cid:80)(cid:68)(cid:81)(cid:70)(cid:72)(cid:86) e g n d a re R at y Yeec ar El l a S l a u n n A n o d ti e a art fili St Af r n/ a o e i Y s s e f o r P s er s b er m b e m M e e s M Staff Titl actor ard ey ntr Bo tle on K nt Co tion Ti zati nde niza ni s e a a n p g g er de Or Or nt n I I of of r r e e b b m m u u N N e e m m a a N N t t s s a a L L aff aff St St s e e er m m e me Full-ti Part-ti Volunt me a a N of of of N st er er er st r b b b r Fi m m m Fi u u u N N N FY2018 Sponsored Organization Budget Form - New York State Council on the Arts(cid:3)(cid:16) Current fiscal year Prior completed Last completed (actual plus fiscal year fiscal year projected) EARNED INCOME Admissions Contracted Services Tuition and Workshop Fees Fundraising Events Other Earned Revenue Total Earned Income CONTRIBUTED INCOME Corporate Support Foundation Support Private Support NEA Support Federal Support State Support (non-NYSCA) County Support Municipal Support Total Contributed Income Other Revenue TOTAL INCOME EXPENSES Personnel - Administrative Personnel - Artistic Personnel -Technical/Production Fringe Benefits Outside Artistic Fees and Services Other Outside Fees and Services Regrants Space Travel Marketing/Advertising Remaining Operating Expenses TOTAL EXPENSES Current fiscal year Prior completed Last completed (actual plus fiscal year fiscal year projected) Surplus (Deficit) Before NYSCA NYSCA Grants Received/Requested Surplus (Deficit) After NYSCA IN-KIND CONTRIBUTIONS In-Kind Contributions ORGANIZATION ASSETS Savings / Checking Accounts Endowment Funds Capital Property / Real Estate FY2019 Sponsored Project Budget Form - New York State Council on the Arts - (cid:51)(cid:85)(cid:82)(cid:77)(cid:72)(cid:70)(cid:87)(cid:3)(cid:37)(cid:88)(cid:71)(cid:74)(cid:72)(cid:87) EARNED INCOME Admissions Contracted Services Tuition and Workshop Fees Fundraising Events Other Earned Revenue Total Earned Income CONTRIBUTED INCOME Corporate Support Foundation Support Private Support NEA Support Federal Support State Support (non-NYSCA) County Support Municipal Support Total Contributed Income Other Revenue TOTAL INCOME EXPENSES Personnel - Administrative Personnel - Artistic Personnel -Technical/Production Fringe Benefits Outside Artistic Fees and Services Other Outside Fees and Services Regrants Space Travel Marketing/Advertising Remaining Operating Expenses TOTAL EXPENSES Surplus (Deficit) Before NYSCA NYSCA Grants Received/Requested Surplus (Deficit) After NYSCA Budget Notes ((cid:21)000character limit) Sponsored Request Form Literature Answer all questionsfor the specific category to which you are applying below on this form, including the Organization Profile, Organization Budget, and Project Budget and return to your Fiscal Sponsor along with your support materials. A completed Sponsored Request Form is required from all sponsored organizations and individuals. In the event that an applicant fails to submit the completed Sponsored Request Form, the application will not be eligible for review. Please review the program guidelines carefully for program prerequisites and eligibility requirements Only complete those questions that correspond to the category for which you are applying: 1. Public Programs 2. Book and Literary Magazine(cid:3)(cid:51)(cid:88)(cid:69)(cid:79)(cid:76)(cid:70)(cid:68)(cid:87)(cid:76)(cid:82)(cid:81) 3. Literary Translation (2000 character limitper question) Public Programs Questions: Artist Name Project ID Artistic/Programmatic 1. Literary Program Overview Describe the curatorial (artistic) approach to the reading series, writing workshop or other pubic program for the request year, including discussion of the artist selection process. Provide a two- sentence biography on 4 of the writers/teachers/literary artists proposed for the request year. (Provide complete roster of proposed writers/teachers on the Literary Presenters' Fact Sheet (see Mandatory Support Materials). (cid:20)(cid:19)(cid:3)(cid:82)(cid:73)(cid:3)(cid:21)(cid:23)