Arts Final Report Form - Passaic County Community College

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Organization:
2015 PCCHC Arts Final Report
PASSAIC COUNTY CULTURAL & HERITAGE COUNCIL
The Passaic County Arts Re-grant Program
CY2015 Final Report
Organization:
Legal/Business Address:
City, State, Zip:
Daytime Phone:
Mailing Address: (if different)
Email Address:
Website:
Chief Admin. Officer:
Title:
Project Director:
Title:
Starting Date:
Ending Date:
SUMMARY OF GRANT IMPACT:
(Please provide figures requested as completely and accurately as possible.)
1. Total number of public activities or events produced as a result of the Arts re-grant: _____
(Total number of performances, workshops, exhibits, etc.)
2. Live Audience
 Number of Adults attending event(s): _____
 Number of Children (18 and under) attending event(s): _____
3. Total audience not attending live event and/or performance but indirectly benefiting through the broadcast
of an event or performance or the publication of literary work: _____
Please check:  Radio  TV  Publication  YouTube  Other:
Indirect beneficiaries refers to individuals “receiving a substantial artistic product through listenership, viewership or readership via
broadcast, internet or publication, etc”. It does not include articles or radio interviews, TV news coverage, advertising, visits to
websites, etc. (For publications, report the number of persons using the materials or copies actually distributed, not the number of
copies printed. For broadcasting, use estimates if reliable sources exist. If no reliable estimates are available, do not include or
substitute with general population information. For internet programs, report specific individual users benefiting from an artistic
product. Re-grantees are not required to have indirect beneficiaries.
Please list TV/Radio broadcast, publication or online activities below:
_____
4. Number of professional artists engaged per event. (If an artist performs in 2 shows, count 2 times) = _____
 Total number of professional minority artists participating (count once): _____

Total number of professional New Jersey artists participating (count once): _____
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Organization:
2015 PCCHC Arts Final Report
CULTURAL DIVERSITY:
The New Jersey State Council on the Arts (NJSCA) requests information on minority participation for statistical
purposes. Please estimate, as accurately as possible, the following categories of minorities.
Of the total number of audience members, estimate percentages for the following: (Total should equal 100%.)
_____ African-American
_____ Hispanic/Latino
_____ Asian-American/ Pacific Islander
_____ Native American/
Alaskan Native
_____ Middle Eastern
_____ Caucasian
____ Other
Additional Statistics: Please estimate percentages as accurately as possible: (Does not need to equal 100%.)
_____ Seniors
_____ Person with Disabilities
NARRATIVE
Use a separate page with your organization’s name at the top. Please number your answers.
1. Provide a brief description of your project with where and when it occurred, and include:
a.
b.
c.
d.
e.
f.
g.
the professional quality of the program and artists;
any special achievements or challenges;
publicity efforts;
the audience’s reaction;
the impact on the community;
success in attracting diverse and/or underserved communities; and,
any interesting anecdotes, noteworthy collaborations or awards.
2. Provide an explanation of the figures indicated on your Project Expenses on page 4 (bulleted lists are
acceptable).
3. How can the Passaic County Cultural & Heritage Council (PCCHC) help you, other than through funding?
Are there any workshops you would like for us to sponsor?
SUPPORT MATERIALS
1. Include up to 5 examples of support materials, including fliers, programs, publications, press releases and
newspaper articles with funding credit to PCCHC highlighted. Photo(s) may be included (with proper
release) as support material, but no longer required. (Digital photos preferred, if submitted.)
2. Only one (1) signed copy of the final report and only one (1) set of support materials should be
mailed/emailed to:
Nicholas Rodriguez
Assistant Director - PCCHC
Passaic County Community College
One College Blvd.
Paterson, NJ 07505
Contact:
[email protected]
973-684-6507
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Organization:
2015 PCCHC Arts Final Report
FINANCIAL REPORT:
Please use provided forms and note:
 Cash expenses are those that you pay for.
 In-kind expenses are services and/or goods donated to your organization and have a documented value.
 You must include the full PCCHC re-grant amount in your income, not just the first half.
 Any monies paid by your organization toward this project (i.e. percentage of administrative salaries, rentals,
transfer from budget) should be listed as income.
 Your income and expenses should be in agreement.
FINANCIAL STATEMENT:
Complete this section last.
TOTAL INCOME
Cash Income (include total grant)
$
In-Kind Income
$
TOTAL INCOME
$
TOTAL EXPENSES
Cash Expenses
$
In-Kind Expenses
$
TOTAL EXPENSES
$
PLEASE NOTE:
 Total expenses should equal total income.
 Total expenses must equal at least twice the amount of the re-grant.
Signature of person completing the report:
Title:
Date:
Daytime Phone:
E-mail:
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Organization:
2015 PCCHC Arts Final Report
PROJECT EXPENSES
Expense Categories
List each expense/describe in narrative
Cash
Expenses
Personnel Salary
(match only)
In-Kind
Expenses
Category
Totals
Total In-kind Expenses
Total Expenses
Technical / Production Staff
Professional Services / Artists
(Fees, Stipends)
Space Rental
Equipment Rental
Supplies / Materials
Photocopying
Printing / Typesetting
Publicity / PR
Postage
(match only)
Hospitality
(match only)
Other (list below)
Total Cash Expenses
TOTALS
 Matching Cash is the amount actually paid for goods and/or services.
 In-kind is the dollar amount of goods and/or services donated.
Remember: You must provide an explanation of the figures indicated above in your narrative.
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Organization:
Report
2015 PCCHC Arts Final
PROJECT INCOME
Include funds from membership, admission fees, registrations, grants, sale of program
ads, local government, private and corporate donations and your organization itself.
Source:
Amount:
PCCHC Regrant (full grant)
TOTAL CASH INCOME
(for page 3)
*Please note: Cash income should equal cash expenses.
IN-KIND INCOME:
These are donated goods and services, for which the organization does not pay cash,
but which have a documented cash value. Examples include: donated administrative
services; rental fees of any space allotted for your project's use for which you are not
being charged; volunteer services; and donated equipment, supplies or professional
services for your project.
Source: (detail contribution, i.e. 7 hours X $10/hour)
Amount:
TOTAL IN-KIND INCOME (for page 3)
*Please note: In-kind income should match in-kind expenses.
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