City of St. Petersburg
Arts and Culture Grant
Application • 2015 - 2016 • General Support Grant
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Organization Name:
Principal Mailing Address:
City, State, Zip:
Organization Website:
Grant Contact Name:
Grant Contact Phone:
Grant Contact E-mail Address:
A.
B.
Organization Mission and History
A. 1
Organization Mission Statement
A. 2
Organization History - Provide a brief narrative or chronological list of the significant events
and/or achievements of your organization, including the date of incorporation and historical
relevance to the City of St. Petersburg. • 1 page
Organization Profile
B. 1
Statistics – Fiscal Year 2014
Please fill out all fields that are applicable to your organization.
FY2013
FY2014
% St. Petersburg Residents
FY2014
Total audience / attendance
Number of subscribers (if applicable)
Number of participating students
Number of participating artists
Number of volunteers
Full time paid staff
Part time paid staff
1
B.2
Key Personnel
B.2.A Key Administrative Personnel - Briefly list the names, positions, education and relevant
work history of UP TO TWO key administrative personnel. Indicate if they are full or part time,
paid or volunteer and the length of time they have been in this position. • 1 page
B.2.B Key Artistic Personnel - Briefly list the names, positions, education and relevant work
history of UP TO TWO key artistic personnel. Indicate if they are full or part time, paid or
volunteer and the length of time they have been in this position. • 1 page
C.
Organization Demographics and Accessibility
C.1
Diversity - The Arts Advisory Committee encourages organizations to reflect the St. Petersburg
community in all forms of art. The organization shall not discriminate because of race, color, religion,
gender, national origin, marital status, age, disability, sexual orientation, genetic information or other
protected category. Describe the current demographic composition of your staff, board, volunteers,
audience and participants. What efforts are made to ensure diversity in your organization’s
administration and reach?
• 1/2 page
C.2
Accessibility - Describe your organization’s plans to ensure that the proposal and associated
activities will be accessible and welcoming to all audiences. Also describe ongoing accessibility efforts.
• 1/2 page
Question
Response
Does the applicant have policies and procedures (including a complaint process) that
address non-discrimination on the basis of disability?
Does the applicant have a staff person that is responsible for compliance with Section
504 of the Rehabilitation Act, Americans with Disabilities Act and Florida Statutes
553?
If yes, what is the name of the staff person responsible for accessibility compliance?
Has the applicant completed the Section 504 Self Evaluation Workbook from the
National Endowment for the Arts (linked) in the last 5 years?
If yes, when was the evaluation completed?
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D.
Organization Strategic Direction
Describe your organization’s strategic approach and how it enhances and/or differs from other
organizations in St. Petersburg. What unique value, programming and opportunities does your
organization offer to our community? • 1/2 page
E.
Proposal Description
F.
E.1
Proposal Overview - Describe the proposal for which you are requesting funding. Include goals,
fully measurable objectives, activities and a timeline. If city funding will be directed to a specific
program, or department, list the goals and objectives of that part of the organization. • 1 page
E.2
Evaluation Plan - Briefly describe your methods and processes for gathering, analyzing and
reporting data to evaluate your programming with the purpose of improving, deciding to
continue, or changing your efforts. • 1/2 page
E.3
Marketing and Plan Strategy - Describe the marketing, promotion and/or publicity plans for
the proposal Also describe how these plans will develop or expand the audience related to the
proposal. • 1/2 page
Impact
Describe the economic and social impact of your organization as a whole and the proposal in particular
on your local community. Include a description of your proposal’s education and outreach activities.
• 1/2 page
Organizations in Category A (annual budget $500,000+), please fill out the following chart:
Estimated Number of:
Response
Instructions to the Applicant
School Based Youth
Benefiting
Enter the number of individuals under the age of 18 that are expected to
be participating in organized school based cultural events. This figure
should reflect a portion of the total individuals benefiting.
Non-School Based Youth
Benefiting
Enter the number of individuals under the age of 18 that are expected to
be participating in non-school based cultural events. This figure should
reflect a portion of the total individuals benefiting.
Elders Benefiting
Enter the number of individuals over the age of 65 that are expected to
benefit from the proposal activities. This figure should reflect a portion
of the total individuals benefiting.
Artists Participating
Enter the estimated number of professional artists that will be directly
involved in providing artistic services specifically identified with the
proposal. Include living artists whose work is represented in an
exhibition regardless of whether the work was provided by the artist or
by an institution. This figure should reflect a portion of the total
individuals benefiting.
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Individuals Benefiting
Give the total number of individuals that are expected to be involved in
proposal activities as artists, non-artists, participants, or audience
members. This number should include the values listed for youth,
elders and artists.
Proposal Events
How many different events will be produced or presented within the
grant period as a part of this proposal? Be sure to list different events,
not performances. For example, a musical performed 10 times is only
one event, but a musical performed 10 times and workshop done once
are two events.
Opportunities For Public
Participation
G.
Each event will have one or more opportunities for public participation.
For example a musical performed 10 times is one event with 10
opportunities for public participation.
Organization Financial Position
Describe the fiscal condition of the organization as it relates to the successful completion of the
proposal. Also describe plans to sustain the proposal activities after the grant period. • 1/2 page
Attachments and Support Material
Please Label all attachments with organization name.
Required Attachments
 Operating Results and Projections worksheet
 Most recently filed 990 / 990-EZ / 990-N Year 2014
 Statement of Position (Balance Sheet) – Most recently ended fiscal year 2014
 Statement of Activities (Income Statement) – Most recently ended year 2014
 Most recently audited financial statements – Categories A and B organizations only
 List of current board members with addresses, phone numbers and affiliations
 List of upcoming season – performances, exhibitions, etc. with dates and venues
 List of past season – performances, exhibitions, etc. with dates and venues
Recommended Attachments
 Samples of evaluation instruments (Limit 3)
 Organizational planning documents, such as long range plan or marketing plan
 CD or DVD that demonstrates your organization
Optional Attachments
 Brochure (Limit 1)
 Press review (Limit 1)
 Program (Limit 1)
 Letters from collaborators or partners (Limit 3)
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