Community Arts Engagement Program
2014 Fellowship Grants Application Form
SECTION 1: INSTRUCTIONS AND BASIC INFORMATION
Instructions
Grant applications must be submitted no later than January 10, 2014 via email to Linda Steele (lsteele@artsmemphis.org).
Paper copies will not be accepted; electronic signatures can be used on the assurances page or the document can be signed
and scanned.
Please see the Request for Proposal for additional information regarding this grantmaking process.
Documentation (ie Board list, 990, audited financials) may be requested at a later date if they are not currently on file.
Applicant information
Organization name
Street address
City, state, zip code
Contact name
Contact title
Contact phone
Contact email
SECTION 2: APPLICATION QUESTIONS
This section must not exceed eight pages of typed text, 11 point font.
Organization overview
1. What is the mission of your organization?
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2. Please provide a brief description of your organization’s work.
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3. How would you describe the values of your organization?
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Engaging underserved populations (see definition of underserved on page 1 of RFP)
Questions 4 – 8 should be completed only by organizations that engage underserved populations as a core
component of their mission and activities.
4. To what extent does your organization engage underserved (see definition on pg. 1 of RFP) populations? What
types of programs or services do you offer to this population?
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5. Roughly how many participants within this specific demographic do you serve on an annual basis? In which
communities do these individuals primarily live?
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6. With what level of success have you engaged underserved populations? What tools or metrics have you used to
measure success?
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7. What challenges have you faced in serving this population? What organizational gaps have affected your ability
to serve this population more successfully?
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8. How do your programs or services that engage underserved populations fit into your larger organizational
mission and goals?
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Questions 9 – 13 should be completed by organizations that are not currently engaging underserved populations
as a core component of their mission and activities.
9. Does your organization provide any outreach and/or community engagement services or programming? Please
describe.
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10. What challenges do you face in serving this population? What organizational gaps may affect your ability to
serve this population successfully?
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11. Why are you interested in serving this population? Why now?
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12. How can this work benefit your larger organizational mission and goals?
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Programmatic improvement
13. How does your organization currently think about programmatic improvement? What processes or structures
are used to reflect on and improve programming?
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Collaboration
14. What community-based organizations, nonprofits, youth organizations, arts organizations, or educational
institutions have you partnered with to design or deliver your programming? How have these partnerships improved
the reach of your programming?
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15. How have you utilized beneficiary feedback or community perspectives to improve the design or delivery of your
programming? How could deeper community engagement benefit the work that you do?
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16. In what ways can increased collaboration with community-based organizations, youth organizations, arts
organizations, or educational institutions improve the quality or reach of your programming?
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Organizational Resources
17. In the Fellowship Grants Request for Proposal, we outline numerous internal and peer group expectations of
grantees. How will you ensure that your organization makes adequate time to conduct the required work in a
thoughtful, rigorous manner?
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Learning and ongoing involvement with the Community Arts Engagement Program
18. In order to improve on your existing work with underserved populations, or to begin developing programming for
this target population, what are your organization’s biggest growth areas? What do you need to do this work
successfully?
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19. What type of learning or experience do you hope to gain as a Fellowship Grant recipient? How will this
opportunity benefit your organization? What aspect of this opportunity is most exciting to you?
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20. With the launch of the Community Arts Engagement Program, ArtsMemphis will be initiating a deep community
engagement process and strategic grantmaking approach. Our hope is that Fellowship Grant recipients will help
support this work and remain involved as the program evolves. How is your organization uniquely positioned to
contribute to the larger goals of the Community Arts Engagement Program?
[Insert text]
SECTION 3: BUDGET INFORMATION
Please provide an organizational budget for the current fiscal year. You may use the below budget form, or attach
your own to this application.
Revenue:
Corporate grants
Foundation grants
Government grants
Individual contributions
Sponsorships
Designated funds from your organization
Admissions and ticket sales
Tuition
Other
TOTAL REVENUE
Expenses:
Salaries and fees (artists)
Salaries and fees (administration)
Production costs
Marketing and promotion
Equipment, supplies, materials
Transportation
Evaluation
Other
TOTAL EXPENSES
SECTION 4: STAFF BIOGRAPHIES
Please provide the names and brief bios for up to two staff members who will be leading this effort for your
organization. You can attach existing staff bios or use the forms below.
Individual #1:
Name
Title
Email
Phone
Date
Signature
Brief biography
(Feel free to use this
space or attach your
own to this
application)
Individual #2:
Name
Title
Email
Phone
Date
Signature
Brief biography
(Feel free to use this
space or attach your
own to this
application)
SECTION 5: ASSURANCES AND ELIGIBILITY
YES
NO
Does your organization have written policies and abide by the following Federal regulations?
Title VI of the Civil Rights Act of 1964
Section 504 of the Rehabilitation Act of 1973
Title II of the Age Discrimination Act of 1975
Does your organization adhere to a five-year requirement to maintain records?
Does your organization have and communicate to employees a Whistle Blower policy?
Is your organization current with respect to its 990 filing?
Has your organization filed a corporate annual report with the State of Tennessee?
We certify that we are committed to fulfilling the expectations of grantees, as specified in the Request for Proposal,
in compliance with the legal requirements and granting procedures. We certify that the information contained in this
application, including all attachments, is true and correct to the best of our knowledge.
Executive Official (Board Chair or other person who is legally able to obligate the applicant):
Name
Title
Date
Signature
Executive Director:
Name
Title
Date
Signature