GRANT REQUEST APPLICATION

DATE ___________________ AMOUNT REQUESTED $ ___________

ORGANIZATION:____________________________________________________

MAILING ADDRESS:_________________________________________________

CONTACT PERSON:_________________________ PHONE ____________________

EMAIL ADDRESS:__________________________________________________

PROFIT/NON-PROFIT_________________________

TITLE OF EVENT/PROJECT___________________________________________

DATE OF PROJECT/EVENT___________________________________________

Please briefly describe project/event planned and use of MAAC funds. Please include dates, estimated costs, ticket charge, expected audience, expected income and how that income will be used. Attach additional pages if needed.

PREVIOUS MAAC GRANT RECIPIENT: (list amount and year(s)_________________

OTHER GRANT APPLIED FOR THIS PROJECT (please list)_____________________

OTHER INFORMATION HELPFUL TO YOUR APPLICATION:_________________

SIGNATURE:___________________________ DATE_________________

DISCLOSURES/ASSURANCES

If a MAAC grant is awarded, the applicant hereby gives assurance that: (Please initial)

1. The activities for which financial assistance is sought will be administered by or under the supervision of the applying organization.

2. The applicant will comply with all applicable City, County, Sate and Federal laws, ordinances and regulations.

3. A complete report on the project and a complete description with digital photographs of how the grant funds were expended will be submitted within 30 days of the projects conclusion.

4. Applicant agrees to refund any MAAC monies not used.

5. All advertising, print materials will include the MAAC and City of Muskogee logos.

SIGNATURE:____________________________ DATE ____________________

Please mail to:

Muskogee Area Arts Council Email:

P.O. Box 3298

Muskogee OK 74402

Muskogee Area Arts Council meets on the 4th Tuesday of each month at 5 PM, except December, at Muskogee Little Theater 311 South 3rd St, Muskogee, Ok. Grant requests are considered at board meetings.

PERTINENT/REQUIRED LOGOS