Let’s Talk About It
Library Discussion Grant
Application
Return by email or mail to Caitlin Patton:
cpatton@nchumanities.org
North Carolina Humanities Council
320 East 9th Street, Suite 414
Charlotte, NC 28202
Phone: (704) 687-1521
Fax: (704) 687-1550
“Let’s Talk About It” is a joint project of the North
Carolina Humanities Council, a statewide nonprofit and
affiliate of the National Endowment for the Humanities,
and the North Carolina Center for the Book, a program
of the State Library of North Carolina/Department of
Cultural Resources and an affiliate of the Center for the
Book in the Library of Congress.
Program Information
Requested Series Title
List Exact Dates of all Program Meetings
Alternative Requested Series Title:
Program Time:
Number of Books Requested:
Sponsor Information
Sponsoring Organization
Is Sponsor a Nonprofit
Organization?
Yes
No
DUNS Number
Federal Employer Identification Number
Sponsor Address
Sponsor Telephone
Sponsor City
State
Zip
Library System
NC and US Districts
NC House District(s)
Sponsor County
Program Site
NC Senate District(s)
US Congressional District
Project Director
Project Director Name (please print)
Project Director Phone
Project Director Address
Project Director Fax
Project Director City
State
Zip
Project Director Email
Treasurer or Financial Officer* (*If no funds are requested this section may be left blank)
Treasurer or Financial Officer
Treasurer or Financial Officer Phone
Let’s Talk About It
Grant Application
Treasurer or Financial Officer Fax
Treasurer or Financial Officer Address
Treasurer or Financial
Officer City
State
Zip
Treasurer or Financial Officer Email
Program Details
Please describe the intended audience(s) for the program and why you think the program will be of interest and value
for your audience(s).
As some series have a limited number of copies, please estimate the intended number of participants:
Where will your programs take place?
Budget (take totals from worksheet below; include worksheet with application)
Outright Funds from the Humanities Council
$ 1,000
Sponsor In-Kind Contribution
$
Sponsor Cash
$
Total Program Budget
$
Program Director
___________________________________
SIGNATURE
Head, Sponsoring Organization
___________________________________
SIGNATURE
Treasurer or Financial Officer*
__________________________________
SIGNATURE
(*If no funds are requested this section may be left blank)
Grant Writer (if not Program Director)
__________________________________
SIGNATURE
About In-Kind Contributions
The North Carolina Humanities Council requires a minimum dollar-for-dollar match on all grant money awarded. Most
grantees meet this match from in-kind sources, such as contributions of time, facilities, supplies, etc. Grantees must verify
the contributed in-kind match. Forms for this purpose will be provided.
Distribute the in-kind contribution sheets to all your potential contributors to complete and sign. You may make copies of
the forms, if needed. The totals of contributed in-kind match must be supplied to your fiscal agent at the end of your
project so that the Statement of Grant Match can be filed.
Fiscal Responsibilities of Sponsoring Agent
a) The North Carolina Humanities Council grant funds will be used to provide stipends for the scholars. The stipends will
total $1,000, based on $200 per scholar for five programs. The grant funds cannot be used for any other purpose.
b) North Carolina Humanities Council grant funds must be matched by in-kind and/or cash contributions at least equal to
the amount of North Carolina Humanities Council funds requested.
Examples of in-kind contributions are:
 the value of time for persons involved in planning or administering the project
 the rental value of a donated meeting room or auditorium
 the value of publicity donated by local outlets
 the value of refreshments
Examples of cash contributions are:
 speaker’s travel, meals, and lodging
LT-4011 Series Grant Application
Let’s Talk About It
Grant Application
Federal Requirement
As of October 1, 2010, under the Federal Funding Accountability and Transparency Act (FFATA), no organization can
receive a sub grant award without providing a Data Universal Numbering System (DUNS) number to the awarding
agency. A DUNS number is a nine-digit number established by Dun and Bradstreet, Inc. (D&B) to uniquely identify
business entities. This number can be obtained from D&B by telephone at 866 705-5711 or through their website,
http://fedgov.dnb.com/webform.
Budget Worksheet
Humanities
Expense Items Council Cash
Contribution
Salaries
Scholar Stipend(s)
Sponsor
Cash
Contribution
Sponsor
In-Kind
Contribution
TOTAL
$
$
$
$1,000
$
Supplies & Equipment Rental
$
$
$
Travel, Meals, Lodging
$
$
$
Facilities Rental
$
$
$
Printing & Publicity
$
$
$
Other (please itemize)
$
$
$
$
$
$
$
$
$
Sponsor Cash
Sponsor In-Kind
Total less
$1,000=
$
$
TOTALS
$1,000
$
NOTE: As with all North Carolina Humanities Council awards, sponsors must MATCH the outright Humanities Council
award dollar-for-dollar. A sponsor can do this either through cash, in-kind contribution, or any combination of the two. For
this program, your organization must match at least $1,000. However, you can offer a higher match and we encourage
you to do so, since your match provides our supporters with a clear indication that this program is important to your
organization and the community you serve.
LT-4011 Series Grant Application
Let’s Talk About It
Grant Application
The Treasurer or Financial Officer named on the first page of this application should complete this form
Treasurer or Financial Officer Information
Sponsoring Organization
Check and sign ONE of the following three options:
1.
I will personally do the accounting for this grant and will sign all fiscal reports.
Print Your Name
Your Signature
Date
Phone Number
I will sign the fiscal reports, but I have designated (cannot be the Project Director)
2.
__________________________________ to prepare the reports.
Signature of Original Signer
Signature of Designee
Date
Phone Number of Designee
I authorize ____________________________ (cannot be the Project Director) to be accountable for this
3.
grant and to sign all fiscal reports on behalf of the sponsoring organization.
Signature of Original Signer
Signature of Designee
Date
Phone Number of Designee
LT-4011 Series Grant Application