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FY19 Special Projects Grant Application

  1. CONTACT INFORMATION

  2. REQUEST SUMMARY

  3. ELIGIBILITY REQUIREMENTS

  4. Eligibility Status*

    Check one Box Only

  5. NARRATIVE

    **Applicants who do not comply with the allotted word limit will be disqualified**

  6. (800 characters including spaces, approximately 200 words)

  7. (800 characters including spaces, approximately 200 words)

  8. 3. How does your project plan to address diversity equity and inclusion in the following aspects?

  9. (800 characters including spaces, approximately 200 words)

  10. (800 characters including spaces, approximately 200 words)

  11. (1300 characters including spaces, approximately 300 words)

  12. (800 characters including spaces, approximately 200 words)

  13. (1300 characters including spaces, approximately 300 words)

  14. (800 characters including spaces approximately 300 words)

  15. 8. Budget

  16. Show evidence of careful event and financial planning by completing the following proposed project budget, expense detail, proposed income, and planning timeline (5 points).

    BUDGET: Only list expenses associated with your proposed project. You must provide some cash resources in your match. Employee or volunteer costs for the project cannot be a grant requested item but can be used for up to 50% of the match but account for no more than 25% of the entire project. Artists should be fairly compensated for their work. Expenses must be incurred from July 1, 2018, through June 30, 2019. **Please use the following section for total figures for the individual expense categories only. The following section will provide boxes to include detailed breakdowns**

  17. Has your organization recieved additional funding from the City of Dubuque in the past 2 years?*

  18. i. EXPENSE CATEGORIES

  19. a. Employee or Volunteer Time

  20. Hours x Rate =

  21. b. Artists

  22. c. Contractors

  23. d. Supplies and Materials

  24. e. Space and Equipment Rental

  25. f. Travel

  26. g. Marketing/Publicity

  27. h. Miscellaneous Costs

  28. g. Total Project Expenses

  29. ii. EXPENSE DETAIL

    If applicable, please briefly add specific information relating to the above expense categories in the allotted space.

  30. Please use the current IRS business rate of 57.5 cents per mile to calculate the mileage rate.

  31. iii. PROPOSED PROJECT INCOME

    List or briefly describe the source and amount expected of cash income for each income category. Do not include in-kind contributions in this section.

  32. 1. Earned Incomes

    (Admissions, tickets, free will offering, etc.)

  33. 2. Cash Contributions

    (Sponsorships, etc.)

  34. 3. Other Cash Revenue

  35. 4. Total Cash Income

  36. iv. TIMETABLE

    Provide a timeline with specific actions required to complete all of the activities of the proposed project. Please include planning activities that take place outside of the grant period so that the entire scope of your planning activities is clear. Use the space bar, not tabs, within this section. Limit your response to this page only.

  37. Supporting Documentation

    If you are a non-profit organization, please attach a copy of your articles of incorporation. If you are an organization affiliated with an umbrella non-profit, please attach a copy of the articles of incorporation of the umbrella organization. If you are an organization acting as a non-profit, please attach a roster of the organizers or committee members, minutes of meetings, flyers, newsletters or other materials from the last six months showing the organization of your group.

  38. Please attach documents ONLY when you are ready to submit. Attachments will not be saved.

  39. ASSURANCES

  40. I hereby certify that, to the best of my knowledge, all of the information contained in this Application is true and correct. I understand that the City of Dubuque reserves the right to request modifications of this Application during the process of contract negotiation, and, as finally approved by the City of Dubuque, the Application shall serve as the work plan of the organization and shall become part of the Contract with the City of Dubuque. The Applicant certifies:

  41. - Agreement to submit further documents as required by the City of Dubuque to determine project and organization eligibility; and

  42. - Agreement to submit a Final Report; and

  43. - Agreement to maintain any other specific records, as may be determined necessary by the City of Dubuque, to the overall evaluation of the project; and

  44. - Agreement to comply with all federal, state, and local regulations governing the project and use of grant funds; and

  45. - Agreement that no costs incurred for the program prior to authorization by the City of Dubuque shall be reimbursable and that any funds not spent during the contract period for the project or after the project is completed will be forfeited; and

  46. - Agreement that the City of Dubuque will fund no more than 50% of the final project budget submitted in the Final Report; and

  47. - Agreement that in the case the project is not completed as planned, the amountn of disbursed funds will be promptly remitted to the City of Dubuque.

  48. For more information, contact:

    Debra Alleyne, Arts & Culture Coordinator

  49. Phone:

    (563) 690-6059

  50. E-mail:

    dalleyne@cityofdubuque.org

  51. Address:

    50 West 13th Street Dubuque, IA 52001

  52. Leave This Blank:

  53. This field is not part of the form submission.