Heathcote Art Foundation

___Emerging Artists Program

___Growth and Stabilization Program

___FACE Croatia Program

Proposal Summary

 
Date of Application:____________________________________________________

 
Organization Name:______________________________________________________

 
Organization Mission (one sentence):____________________________________

 
________________________________________________________________________

 
What distinguishes organization from others in the field (one sentence) 
 
________________________________________________________________________

 
________________________________________________________________________

 
Purpose of Grant (one sentence)_________________________________________

 
________________________________________________________________________

 
Grant Request: $________________________________________________________

  Check One: 
    General Support _____ 
    Project Support _____ 
 
Amount allocated for artist fees, if any:_______________________________

 
Address of Organization:________________________________________________

 
________________________________________________________________________

 
Telephone Number:_______________________________________________________
 
Email Address:__________________________________________________________

Fax Number:_____________________________________________________________

Web Address:___________________________________________________________
 
Executive Director:_____________________________ Since:_________________
 
Development Contact:____________________________________________________
 
Is your Organization an IRS 501(c)(3) Not-for-Profit?___________________

 
Fiscal Year Ends (month/day):___________________________________________

 
Total Organizational Budget (for current year): $_______________________
                                   (last year): $_______________________

 
Actual sources of income (current): 
 
  $_________ of which $________ Earned 
 
Donations 
 
Individual: $_________  Corp: $_________ Fdn: $_________  
     Loans: $_________ Other: $_________ (please indicate % of Board
Support) 
 
Total Project Budget (if requesting project support): $_________________

                                         (last year): $_________________

 
List of 5 largest foundations/corporate or individual donors with amount
given in current fiscal year:___________________________________________

 
________________________________________________________________________

 
Projected donors and amounts for next fiscal year:______________________