Contact Information for PCCHC:
Passaic County Cultural & Heritage Council
Passaic County Community College
One College Boulevard
Paterson, NJ 07505
(973) 684-5444 www.pccc.edu/pcchc
Maria Mazziotti Gillan, Executive Director
Susan Balik, Associate Director ( sbalik@pccc.edu
)
Nicholas Rodriguez, Assistant Director ( nrodriguez@pccc.edu
)
Th e Passaic County Cultural and Heritage Council’s History Re-grant Program is made possible by a general operating support grant from the New Jersey Historical
Commission, a division of the Department of State.

Applicant: History Re-grant Application FY 2016
1. By Thursday, July 16, 2015 please return one original and three copies (total 4) of the completed application and support materials. Applications must be postmarked by this date or dropped off at our office by 4 p.m. at the Hamilton Club Building, 32 Church Street, in downtown Paterson. Mailing Address: Passaic County Cultural and Heritage Council,
Passaic County Community College, 1 College Boulevard, Paterson, NJ 07505.
2. Read the Guidelines and Application carefully before completing.
Failure to complete your application correctly may disqualify your application.
3. Please be sure to sign the original in BLUE ink.
4. Your project description and budget must reflect events in the 12-month period from July 1,
2015 to June 30, 2016.
5. Applications must be typed; Download the application at: http://www.pccc.edu/culturalaffairs/pcchc.
6. Fill in the name of your organization at the top of each page.
7. Staple application at the upper left corner; clip support materials. No binders or plastic containers, please.
8. Please note: All of the following pages are part of this application, and the entire application will be made a part of a contract between your organization and the Passaic
County Cultural and Heritage Council, if your application is successful.
Organization:
Legal/Business Address:
City, State, Zip:
Mailing Address: (if different)
__ Federal I.D. #
Daytime Phone:
Email Address:
U.S. Congressional District:
Website:
N.J. Legislative District:
Chief Admin. Officer:
Starting Date:
Project Director:
Project Director ’s email (if different):
Title:
Daytime Phone:
Ending Date:
(Must fall between July 1, 2015 and June 30, 2016)
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Applicant: History Re-grant Application FY 2016
Is your organization a (must select one):
 Non-profit
 Government entity
Which of the following best describes your organization?
 History organization
 Museum
 Historic site
 Historical society
 Library
 Educational organization
 Community organization
 Religious organization
 Other:
Amount Requested: $
(You may request re-grants of $500 to $2,500.)
Brief Project Description (In 100 words or less , please answer who, what, where and when,
AND include brief description of audience being served.)
COMPLETE THIS BUDGET SUMMARY AFTER COMPLETING PROJECT BUDGET ON PAGE 7.
A . Amount Requested from PCCHC $
B. Cash Match
Must be at least 50% of A .
$
C. TOTAL BUDGET ( A + B ): $
Be sure your figures match the figures on page 7. Complete this question last.
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Applicant: History Re-grant Application FY 2016
Separate sections are provided for each category, including:
A. Narrative, p. 6
B. Project Budget (expenses & income ), p. 7 - 8
C. ADA Accessibility Fact Sheet, p. 9
You are limited to five examples of your work, and must include four (4) copies of each . This does not count your tax-exempt certification, resumes, and board listing.
Support Materials may include the following:
 Programs
 Brochures
 Flyers no larger t han 8” X 12”; no posters please.
 Up to 10 photographs in print or photocopy format; no larger than 8" X 10". (Please include only one set and no albums.)
 DVD or CD (please only include one).
 Published work or manuscript (book [include only one], catalog, article, etc.).
Support materials may be picked up at the Passaic County Cultural and Heritage Council in
October, after the History Re-grant Panel has had an opportunity to review them. If these items are not picked up by December 1, copies will be discarded . The Passaic County Cultural &
Heritage Council assumes no liability for the preservation or return of support materials. We strongly recommend you do not send originals.
 List of your Board of Directors or Trustees.
 Please submit resumes of the project director, history professionals, and any other personnel executing the program or project. (This is required.)
 Non-Profit status : All non-governmental applicants include one copy of the organization's tax-exempt status ruling, or letter from the Internal Revenue Service. If you have not obtained such a ruling, you must provide a copy of your letter to the IRS applying for such status. Please contact PCCHC if you have questions about this requirement.
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Applicant: History Re-grant Application FY 2016
I understand that the following pages and attachments constitute part of this application.
I certify that all statements in this application are true to the best of my knowledge; and I hereby release the Passaic County Cultural and Heritage Council, its employees, and agents from any liability and/or responsibility concerning any submission of materials to the program. I further certify that any funds received under the Passaic County History Re-grant Program will be used exclusively for the purpose set forth in this application, and that I will notify the Passaic County
Cultural and Heritage Council immediately in the event my organization receives direct funding for the fiscal year 2016 for the same project from the New Jersey Historical Commission. I understand and agree that submission of an application signifies intention to comply with Title
VII of the Civil Right Acts of 1964 (PL 88-352), with Labor Standards under Section 5 (1) of the
National Foundation on the Arts and Humanities Act of 1965 (PL 185 - 209), Title IX of the
Education Amendments of 1972, and Section 504 of the Rehabilitation Act of 1973.
Chief Administrative Officer (please print)
Chief Administrative Officer Signature
Project Director (please print)
Project Director Signature
Title
Date
Title
Date
Have you applied, or do you intend to apply, to the New Jersey Historical Commission directly for funding for fiscal year July 1, 2015 – June 30, 2016?  Yes  No
(You may receive a PCCHC re-grant if you are receiving general operating support or project support from the NJ Historical Commission directly; however, you may not apply for funding for the same project.)
Have you applied to the Passaic County Cultural & Heritage Council for an Arts Re-grant for calendar years 2016?  Yes  No
(You may receive funding for an Arts project and a History Project through the PCCHC; however, you may not apply for funding for the same project.)
Did you have an in-person meeting with PCCHC to review your application?  Yes  No
PCCHC Contact person: Meeting Date:
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Applicant: History Re-grant Application FY 2016
Use the list below to guide you in completing your narrative. Be sure to answer all questions, and number each section.
If necessary, one additional page may be attached and should be numbered 6b.
1. Describe your organization’s mission, history, programs and goals. Non-history organizations need only describe structure and activities relevant to history.
2. What is your project ? Specify the historical focus, subject and time period. It is important to illustrate preliminary planning.
3. Who are the professionals involved with this project and their roles? Attach resumes/bios.
4. When and where will the project take place (include timeline)?
5. Who are your target audiences for this project (persons who will be served under the grant)?
Describe demographics, potential size, age and geographic area. How is your organization serving Passaic County’s diverse communities? What percentage of your audience is minorities, senior citizens, disabled, school children, etc.?
6. Describe your publicity plan. How will you make your target audiences and the general public aware of your program?
7. Must provide an explanation of the figures indicated on your Project Expenses (page 7).
8. If full funding is not recommended or not possible, given amount of funding received from the state, how would you adjust your budget? Will you still be able to complete your project, and, if so, what changes would you make in order to do so.
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Applicant: History Re-grant Application FY 2016
Budget figures must reflect the period between July 1, 2015 and June 30, 2016.
Expense Categories
List each expense and describe in
Narrative #7.
Requested
From PCCHC
Matching
Cash (must total
50% of request)
Category
Totals
Administrative Personnel Salary N/A
Technical / Production Staff
Professional Services / Historians /
Researchers (Fees, Stipends)
Space Rental
Equipment Rental
N/A Equipment Purchases
Supplies / Materials
Photocopying
Graphic Design / Printing
Publicity
Postage / Telephone
Hospitality
Other (list below)
TOTALS A.
N/A
N/A
B.
C. Total Budget
Note: A and B should correspond to the Budget Summary on page 3.
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Applicant: History Re-grant Application FY 2016
Include expected funds from local government, private and corporate donations, memberships, registrations, anticipated admissions/tickets, grants ( other than PCCHC Re-grant), sale of ads in programs, contribution from your organization and other sources of anticipated income.
Amount: Source:
$
$
$
$
Total Project Income
Amount Requested from PCCHC
Grand Total (same as on Expenses Chart and Budget Summary)
$
$
$
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Applicant: History Re-grant Application FY 2016
This questionnaire or an ADA Compliance Plan must be completed for funding evaluation.
Those organizations that have already submitted an acceptable ADA Plan are exempt from completing this form, but must attach a copy of their ADA Plan. If you have not completed an
ADA Plan, tools to guide you through the process are https://njtheatrealliance.org/ada-planning .
Funding Guidelines : Applications will be evaluated for sensitivity to persons with disabilities and seniors. Ensuring that programming funded by PCCHC is available to the widest possible audience is a priority of the PCCHC and the New Jersey Historical Commission. Organizations are expected to provide programmatic, as well as physical accessibility. At minimum, organizations should offer large print programs, flyers, etc. and assistive listening devices, available for loan, free of charge, from the NJ Theatre Alliance and public libraries listed in the guidelines.
Please note: Because access for people with disabilities, as directed by federal law, usually requires long-range planning and budgeting, PCCHC encourages applicants to consider access issues in the early planning stages of programs and services. Cost of program accommodation for people with disabilities (for example, audio descriptions of printed material; exhibitions, presentations and seminars; staff training; large print labels or programs; and direct mail advertising on access services) are generally eligible project costs .
Please Check One:
 ADA Plan was submitted in _________ (year) and copy is attached .
 Accessibility Fact Sheet will be completed in lieu of ADA Plan
Organization:
Name of person completing questionnaire:
Date Prepared: Contact phone number:
1. Will key project personnel be provided with appropriate information and training in disability awareness and serving audiences with disabilities?  Yes  No
A. What has your organization done to educate the organization’s officers, board, and staff about accessibility for people with disabilities? Include ADA compliance and/or sensitivity training workshops.
2. Does the organization operate from its own facility?  Yes  No
A. If yes, is the facility  Fully Accessible  Partially Accessible  Not Accessible
If the facility is not fully accessible, or not accessible at all, describe the organization’s plan for making it fully accessible. Attach a separate sheet for your plan and timeline, if needed.
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Applicant: History Re-grant Application FY 2016
B. If no, how will you ensure that the facility/facilities that you will use for this project will be accessible? (For example, survey the accessibility of the facility.)
3. The organization’s programming is accessible for the following disabilities:
(for example, physically disabled, sight impaired, or hearing impaired).
4. Does your organization provide and publicize the availability of the following program accommodations on request? ( Please Note: These are not requirements, but goals to strive towards. Check all that apply.)
 Large Print Publications / Labels  Sign Interpretation
 Assistive Listening Devices
 Other:
 Tactile Exhibits


Audio Description
Braille Publications
A.
In the next 12 months, what are the organization’s plans for making programs and services more accessible to people with disabilities? (Attach a separate sheet, if needed.)
5. Has your organization budgeted to provide programmatic accessibility and accommodations for this project?  Yes  No
6. Please explain how persons with disabilities will be targeted as an audience or participants of your organization. (For example, sending announcements or flyers to organizations serving the disabled and seniors, offering discounts to these groups, and using accessibility symbols and statements on your publicity materials.)
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Applicant: History Re-grant Application FY 2016
All completed Re-grant Applications must contain the following:

Completed Application Form and support materials (4 collated copies total).
Please remember:
 Fill in all requested information.
 Get original signatures in blue ink .
 Carefully word your brief project description (100 words or less).
 Present the correct cash match.
 One copy of the organization’s tax-exempt status ruling (if a non-government entity)

Narrative

Project Budget

Support Materials

List of your Board of Directors or Trustees

Resumes of project personnel and professionals

ADA Plan attached or Accessibility Fact Sheet completed
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