City of Orem CARE Program
Cultural Arts Major Grant, 2014
APPLICATION COVER SHEET
Project Title:
Amount Requested:
Name of Applicant Organization:
Contact Person:
Title:
Phone:
Fax:
Email:
On behalf of my organization, I am submitting 1 original and 10 copies of the application requesting
CARE funding for the Cultural Arts Major Grant project described herein.
I hereby acknowledge that, to the best of my knowledge, the following information submitted to the City of
Orem CARE Program is correct and that I have the authority to bind this applying organization to the
project:
Signature: ________________________________________ Title:
Print or Type Name:
Date:
Organization:
Address:
City, State, Zip Code:
Mailing Address (if different from above):
City, State, Zip Code:
Phone Number:
Organization Website (if available):
____________________________
The signed, original application and copies must be received in the
City of Orem Recorder’s Office by 5:30 PM on Thursday, March 20, 2014.
Submit Applications to:
CARE Program
c/o City of Orem Recorder’s Office
56 North State Street, Room 101
Orem, UT 84057
-1-
City of Orem CARE Program
Cultural Arts Major Grant Application, 2014
Note: To keep formatting uniform, please tab through fields instead of using the enter button.
PART ONE – GENERAL APPLICANT INFORMATION
Applicant Eligibility
Is your organization located within the City of Orem1?
Does your organization maintain nonprofit status2?
Yes
No
Federal Tax ID Number (Required):
Date of Incorporation:
Attach a copy of your organization’s IRS 501(c)(3) letter with your completed application.
Please note your organization’s primary eligible discipline (see the Appendix for selections):
Category of Eligible Discipline:
Subcategory of Eligible Discipline:
Yes
No
Is your organization affiliated with a college, university or educational institution?
If so, does the institution receive more than 50% of its funding from state funds?
Is your organization a cultural organization?
If no, it is unlikely that your organization will be eligible for this grant funding. According to Utah State Code
59-12-702:
Cultural organization means a private nonprofit organization or institution having its primary
purpose the advancement and preservation of: natural history, art, music, theater, dance or
cultural arts, including literature, a motion picture, or storytelling.
Cultural organization does not include a radio or television broadcasting network or station, cable
communications system, newspaper, or magazine.
An organization is considered located within the City of Orem if it has a significant presence, and manages/presents in the City
of Orem.
1
An organization is considered an eligible nonprofit if it’s 501(c)3 status is current and if it can provide a copy of its 501(c)(3)
letter as provided by the Internal Revenue Service.
2
-2-
Executive Summary - In order to maintain perspective while reviewing your application, please provide
a short summary of who you are, why you are applying, and what you propose to do with the funds (limited
to 600 characters).
PART TWO – ORGANIZATIONAL INFORMATION
Use the pages below to complete this portion of the application. Address each of the following issues and
questions using only the allotted spaces for the following narrative. Clarity and brevity are encouraged.
Each box has a maximum number of allowed characters. Please adjust the amount of text and
spacing to insure that the bottom border of each box is visible before printing the final version of
your application. If you experience formatting difficulties while cutting and pasting from other
documents, please type your information directly into the boxes. Thank you!
-3-
1. Mission/Goals: Provide the mission statement, major program areas, a brief history, and major
accomplishments of your organization. Describe your short-term and long-term operational goals
and objectives, and your plans for achieving them (limited to 1,500 characters).
-4-
2. Program Qualifications: (a) Explain how your organization qualifies under the primary discipline
classification you indicated above on this application. (b) Private nonprofit cultural arts
organizations often engage in commercial activities that provide a source of revenue for cultural
activities but which in and of themselves would not be classified as cultural arts. Describe any of
your organizations activities which fall outside the stated “eligible disciplines” found in the
Appendix. (limited to 750 characters)”
3. Board & Staff: Briefly describe your organizational structure and the roles and responsibilities
of key staff member and/or consultants. Describe the roles and responsibilities of your Board
of Directors, including a description of how closely your Board of Directors and/or
subcommittees work with the organization’s daily operations. Attach a one-page
organizational chart including both the title and the name of individuals filling key positions,
and a list of names, addresses and contact information for your current Board of Directors
(limited to 1,000 characters).
-5-
4. Activities: Describe your organization’s major activities in the past year. Specify in detail
particular successes and challenges (limited to 1,250 characters).
5. Outreach: How does your organization promote or market its work (limited to 750 characters)?
-6-
6. Community Served: Describe your primary and/or target audience. Explain how you track the
number of participants or audience members that attend your programs. Estimate the number
of Orem residents that were served by your organization in the past year. Explain how your
organization intends to maintain and/or grow its audience over the next year.
a. The purpose of the following list is to provide information on the scope and type of
activities your organization provides in the City of Orem and the audience or
constituency served. Please list activities for the past 12 to 18 months, providing as
close to actuals as possible in terms of attendance. Summarize, where appropriate;
you do not need to list every individual event. You may group program activity into
types, i.e., regular season, mainstage, outreach, touring, special exhibitions,
educational, residencies, etc. Include only events held in the City of Orem.
Note: To keep formatting uniform, please tab through fields instead of using the
enter button.
Date
(month/yy)
Location
(street address, city)
Event
(name or type and brief description)
-7-
Number of
people in
attendance
7. Educational Institutions: If your organization is an educational institution, describe how your
organization serves community audiences other than students and faculty. Provide an
estimate of the percentage of your total audience that is non-student or faculty (limited to 750
characters).
8. Collaboration: Identify and explain how your organization partners with other organizations
and service providers located within the City of Orem.
Organization
Collaboration Efforts (How)
(please indicate whether city, county, state,
federal, or nonprofit)
-8-
Organization Finances
1. Funding: Describe what sources of funding your organization secured in the past 12 months, and
what percentage of your budget comes from donated funds (limited to 750 characters).
2. Expenditures: Describe what percentage of your total expenditures is spent within the City of
Orem. Describe what percentage of your costs is spent for direct service (programming) to the
population versus the percentage spent for administrative costs (limited to 500 characters).
3. Financial Reports: Organizations requesting amounts of $10,000 or more are required to attach
financial reports for their organizations prepared by a Utah licensed certified public accountant/firm
according to the following schedule:
a. $10,000 to $99,999 – a compilation report for the most recently completed fiscal year;
b. $100,000 to $499,999 – a review of the most recently completed fiscal year plus a
compilation report for the previous two fiscal years;
c. $500,000 or more – a review for the most recently completed fiscal year and the two
previous fiscal years.
4. Revenue and Expenditures: In addition, please complete the tables below, filling in all applicable
items as a summary of your organization’s revenue and expenditures. Definitions for each category
are provided in the Appendix of the Application Instructions. Organizations requesting amounts of
$10,000 or more should take the revenue and expenditure summary information for 2012 and 2013
directly from the required financial reports.
-9-
REVENUE SUMMARY
1.
2.
3.
4.
5.
6.
7.
8.
9.
2012
2013
Projected
2014
2012
2013
Projected
2014
Admissions and Earned Income
Other Event Income
Contributions (Corporate)
Contributions (Individual)
Orem CARE Grants
Grants (Government excluding CARE)
Non-government Grants
Investment Income
Rental Revenue
10. Other Revenue*
11. TOTAL REVENUE
*Other Revenue: if over 10% of budget, explain why:
EXPENDITURES SUMMARY
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
Administrative Salaries and Benefits
Number of paid full time staff
Number of paid part time staff
Program Salaries and Benefits
Program Independent Contractor Fees
Exhibition Operating Expenses
Materials
Royalties/Licensing Fees
Travel and Housing (including per diem)
Marketing
Development
Office Expenses (including Ticket Office and Front of
House)
Facility Rent
Operations and Maintenance
Miscellaneous Program
Miscellaneous Administrative
Accounting and Legal
Other Expenditures
SUB-TOTAL QUALIFYING EXPENDITURES
- 10 -
31.
32.
33.
34.
Capital Construction Expenses
Cost of Goods Sold (Concession/Gift Shop)
Payments into an Endowment Corpus
Operating expenses for activity outside of the City of
Orem
35. Activities not available to the general public
36. Fundraising Expenses Related to Capital or
Endowment Campaign
37. Repayments of Loans and/or Interest thereon
38. Expenditures for Political Lobbying
39. Grants (given to others)
40. Bad Debt Expense
41. Real Property Depreciation
42. Non-deductible Tax Penalties/Unrelated Business
Income Tax
43. Other expenses not related to the organization’s
primary cultural purpose*
44. SUB-TOTAL NON-QUALIFYING EXPENDITURES
45. TOTAL EXPENDITURES
*Other expenses not related to the organization’s primary cultural purpose, explain here:
If your total revenues or expenditures have increased or decreased by 25% from last year, please explain
why (limited to 500 characters):
- 11 -
5. Confidentiality of Financial Information: Under Utah Code Annotated 63-2-304(2)(a)-(b), your
organization’s financial information may be classified as protected and kept confidential by the City,
if you provide the following claim of business confidentiality and provide the following statements of
reasons supporting the claim of business confidentiality:
Do you claim that your financial information is subject to business confidentiality?
Yes
No
If yes, please write a concise statement of reasons supporting your claim of business confidentiality
by answering the following questions:
a. Would disclosure of your organization’s financial information reasonably be expected to
result in unfair competitive injury to your organization or would it impair the ability of the
governmental entity to obtain necessary information in the future? If yes, explain. (See
Utah Code Ann. 63-2-304(2)(a))
b. Does your organization have a greater interest in prohibiting access to its financial
information than the public has in obtaining access? If yes, explain. (See Utah Code Ann.
3-2-304(b))
c. Do you have any other reason(s) to support your claim of business confidentiality? If yes,
explain.
PART THREE – PROJECT INFORMATION
Use the pages below to complete this portion of the application. Address each of the following issues and
questions using only the allotted spaces for the following narrative.
- 12 -
1. Project Overview: Describe in detail the project for which you are requesting CARE tax funds,
including the purpose of the project, and the need for the project, and how the project is above
and beyond your normal operation. Describe how you plan to execute the project. Will
volunteers be used to carry out this project? Provide a timeline/completion deadline and any other
relevant details that will be helpful in evaluating the project (limited to 2,500 characters).
- 13 -
2. Project Funds List: What time period are you asking for funds? List in detail how funds are to be
used. Please be aware that if your organization is awarded CARE grant monies, your contract
specifications will be directly extracted from this section (limited to 2,000 characters).
What is the total amount of your funding request? $
How will requested funds be used? Check one
Specific Project
Operating Expenditures
Both
Complete the following table detailing your proposed use of requested CARE funds. Definitions for each
category are provided in the Application Instructions Appendix.
- 14 -
PROPOSED USE OF REQUESTED CARE FUNDS
1. Administrative Salaries and Benefits*
2. Program Salaries and Benefits*
3. Program Independent Contractor Fees
4. Exhibition Operating Expenses
5. Materials
6. Royalties/Licensing Fees
7. Travel and Housing (including per diems)
8. Marketing
9. Development
10. Office Expenses (including Ticket Office Expenses)
11. Facility Rent
12. Operations and Maintenance
13. Miscellaneous Program
14. Miscellaneous Administrative (please describe)
15. Accounting and Legal
16. Other Expenditures**
17. TOTAL REQUESTED FUNDS
AMOUNT
* If CARE funds will be used for any personnel, provide details below or on a separate spreadsheet
listing position titles and proposed salaries and benefits.
**Other Expenditures: If this number is over 10% of your total Proposed Use funds, please detail below.
- 15 -
3. Project Contributions: Describe the financial and/or in-kind contributions to this project
that will come from non-CARE resources. Please provide details of the expected
contributions (limited to 1,000 characters).
4. Community Impact: Describe how this project will enhance the quality of life for residents
of Orem, and how you plan to make the project available to all City of Orem residents.
Describe who and how many you hope to serve/reach as a result of this project, including
how this differs in size and scope from previous years (limited to 1,000 characters).
- 16 -
5. Measurable outcomes: Describe how you will demonstrate measurable outcomes of the
success of this project (limited to 1,000 characters).
6. Sustainability: Describe your long-term strategies for financially sustaining this project in
perpetuity. Answer this if applicable (limited to 1,000 characters).
- 17 -
7. Collaboration: Describe any collaboration with other agencies that will result from this
project. Are you collaborating with any other City, County, State, or Federal entity, or
nonprofit organization in pursuit of funding for this project? Please note whether you will
be requesting collaboration or you have obtained a firm commitment for
collaboration.
Please keep this section specific to the project, since you have already described
your organization’s overall collaboration above.
Organization
Collaboration Efforts (How)
(please indicate whether city, county, state,
federal, or nonprofit)
- 18 -
PART FOUR – ATTACHMENTS CHECKLIST
Use the following checklist to ensure that your application is complete. If you have any questions about the
application process, please contact the CARE Program Coordinators at the City of Orem: 801-229-7115 or
care@orem.org
Submit 1 original and 10 copies of following materials, paper clipped, 3-hole punched, DO NOT
staple. Applications may be printed in black and white.
Application
completed in full according to the guidelines found in the application instructions, including
Community Impact table, Organization Finances tables, and Proposed Use of CARE Funds table.
Copies
of certified financial reports as required by the schedule detailed in this application.
Copy
of Organization's IRS 501(c)(3) letter. Nonprofit status may be verified online with the IRS at
http://apps.irs.gov/app/pub78
An
Organizational Chart including both the title and the names of individual filling key positions (include
consultants if appropriate).
Current
Do
names, addresses and phone numbers of Board Members.
not submit any materials not specifically requested.
Do
not submit application or accompanying attachments in binders, clear jackets, folders, etc.
Such material will only be discarded.
Applications must be received in the City of Orem Recorder’s Office, Room 101 of the
Orem City Center, 56 N State Street,
by 5:30 PM on Thursday, March 20, 2014.
LATE APPLICATIONS WILL NOT BE ACCEPTED
- 19 -
APPENDIX – ELIGIBLE DISCIPLINES WORKSHEET
Please mark the primary discipline and/or check the appropriate subcategories where appropriate.
The discipline you select must match what you indicate on page 2 of the application.
Architecture:
Historical Preservation
Service & Education
Other (please indicate):
Arts Education:
Performances for Children/Students
Classroom or After-School Instruction
Teacher and Artist Training
Service/Information and Referrals
Dance:
Ballet
Dance Service Organization
Dance Training
Historical/Traditional
Interdisciplinary
Jazz
World
(ethnic)
Modern
Tap
Other
(please indicate):
Folk Arts: Folk arts are defined as the homegrown traditional artistic activities of groups that share the
same ethnic heritage, language, occupation, religion or geographic area. They are also community
and/or family-based arts that have endured through several generations that carry with them a sense of
community aesthetic, and that demonstrate the highest degree of artistic excellence.
Crafts
Traditional Performing Arts
Stories/Oral History
Humanities: Humanities are defined as promoting, and public education of, the branches of learning or
study embraced by philosophy, literature, languages, and art criticism, but excluding theology, natural
and social sciences.
Lecture Series
Symposium/Conference
Interdisciplinary/Performance Art: An artistic hybrid, combining two or more disciplines within a
single artwork or performance piece. Please indicate disciplines incorporated:
Literature:
Press
Prose, poetry or nonfiction
Literary
Service Organization
Magazines and newspapers are ineligible
- 20 -
Media Arts
Animation
Digital Media
Graphic Design
Independent Film
Multidisciplinary
Video
(within media arts)
Radio and TV broadcast and cable are
ineligible
Multi-Disciplinary: Organizations whose activities encompass two or more distinct disciplines, e.g.
music and visual arts.
Please indicate incorporated disciplines:
Music:
Blues
Classical
Contemporary/New Music
Historical/Traditional
Jazz
Opera
World
Other
Music
(please indicate):
Natural History: Natural history is defined as the study and research, and fostering the appreciation, of
the material universe, including various types of plant and animal life, dinosaurs and other fossil life,
rare gems, minerals and meteorites, human evolution, human cultures, and the origin of life. This also
includes exhibitions related to human beings, the earth and its environment, but excludes aeronautics,
space exploration, and science and technology. Natural history organizations should be primarily
focused on public programs, as opposed to academic research.
Presenting Organizations: Organizations that curate programs and arrange public performances to
help expand public appreciation of diverse art forms and reflect the community’s interests. Presenting
organizations typically assume all or part of the financial risk of the performances, and handle some or
all of the production, marketing box office venue house management tasks associated with the
performances. Presenters also sometimes commission new work, supporting artists to develop and
perform this work.
Theatre:
Classical/Revival
Contemporary/New Work
Musical Theater
Other (please indicate):
Visual Arts:
Ceramics
Digital
Gallery/Exhibition Space
Mixed Media
Museum
Painting/Drawing
Photography
Printmaking
Sculpture/Three-Dimensional
Other
- 21 -
(please indicate):