NWT Arts Council Funding Application for Film and Media
All applications must have this page completed to be considered for funding.
Section A - Project Summary and Check List
Applicant’s Name:
Amount of funding requested
Community:
$
Project Title (25 words or less):
Funding category (check one)
___ Professional Development
___ Creation/Production
___ Presentation
Please use this check list to ensure that your application is complete. Incomplete
applications will be disqualified.
___ Section A - Project Summary and Check List
___ Sections B1 or B2 - Individual OR Group Information
___ Section C - Project Schedule
___ Section D - Project Proposal with detailed description on separate page
___ Section E - Background Materials Summary
__ a. Artistic or Group Resume including Individual Bios
__ b. Price quotes or letters of confirmation for professional services
___ Section F - Support Materials
__ a. Examples of your work (minimum of 3, listed on the SECTION F SUPPLEMENT page)
__ b. Letters of Support (minimum of 2)
___ Section G - Project Budget with detailed budget on separate page
___ Section H - Presentation to the Public
___ Section I - Applicants Statement with Signature
NWT Arts Council Application – Film and Media
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Section B1 - Personal Information (individual applicants)
Last name
Social insurance
Firstnumber
name
Mailing address
Telephone Number (daytime)
Community and Province
Years as NWT resident
Postal code
Ethnic origin (optional)
Age (optional)
Fax Number
E-mail Address
Section B2 - Group Information (group or organization applicants)
Name of group or organization
Contact name and position
Mailing address
Telephone Number (daytime)
Community and Province
Postal code
Type of organization
_____ Non-profit
Fax Number
E-mail Address
_____ Aboriginal organization
_____ Other
If you are a registered non-profit organization, please provide your four-digit
NWT Societies Registry number.
______________ SOC #
______________ Year of registry
Section C - Project Schedule
How many months/weeks will your project take?
Estimated Start Date _________________________________
Estimated Completion Date ___________________________
Will you be working on your project full-time? ________________________________________________________
Will you also be working, attending school or be otherwise occupied? ____________________________________
NWT Arts Council Application – Film and Media
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Section D - Project Proposal (provide a detailed description on a separate page)
On a separate sheet of paper, please outline your project in no more than 750 words. You will be evaluated on
how you describe your project and its outcomes. You are required to provide the following information:
a)
Artistic purpose or goal of the project: how will this project enhance your ongoing artistic development
and/or your career?
b)
How do you plan to carry out your project? Please remember to include the following: when you will
perform/be published, the publisher/editor, the producer, any other writers involved, instructors and
manufacturing details.
c) Community impact: describe the impact that your project will have on the community.
Section E – Background Materials Summary
You must provide the following support materials listed below or you may not be considered for funding.
_____ Artistic resume (individuals or workshop instructors), including Group Background or individual Member
Biographies
_____ Price quotes for professional services
_____ Minimum 2 support letters from individuals excluding family or project participants (list under Section F)
Section F – Support Materials
You must submit examples of your work. These may be CDs, mp3’s, YouTube links, videos, posters, books,
scripts, manuscripts, digital and promotional materials or photographs of your work. Clearly indicate which
paragraph or page number you would like the members to begin review.
DO NOT SEND ORIGINAL MATERIALS. SAMPLES WILL NOT BE RETURNED.
List your examples on the SECTION F SUPPLEMENT page provided.
Provide 2 or more letters of support from individuals or organizations (excluding family or project participants).
They can be originals, faxes or e-mails. List names below of those who will provide you with these references.
1) _________________________________________________________________________________________
2) _________________________________________________________________________________________
3) _________________________________________________________________________________________
NWT Arts Council Application – Film and Media
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Section G – Project Budget with details of budget on a separate page.
Amount of Funding Requested - NWT Arts Council will fund up to a limit of 80% of total project budget.
REVENUES (List all projected revenues)
REQUESTED FROM NWT ARTS COUNCIL (limit of 80% request of total budget)
$
Federal Funding Requested
$
Other GNWT Funding Requested (name Department or Program)
$
Municipal Funding Requested
$
Fundraising Efforts
$
Applicant’s Resources (in-kind, sweat-equity, etc.)
$
Other Matching Sources (please be specific)
$
$
TOTAL REVENUES
$
EXPENSES (List all projected expenses)
Studio Space or Venue Fees
$
Scriptwriting or Option Fees
$
Story consultants (# of consultants ____ + # of days ______)
$
Producer/Editor/Legal Fees
$
Equipment Rentals
$
Materials/License Fees
$
Pre/Post-Production Costs (specify what these are)
$
Travel/Accommodations
$
Workshop, Professional Courses or Instruction Fees
$
Other Professional Fees (specify what these are)
$
Other (please be specific)
$
$
$
TOTAL EXPENSES
$
NWT Arts Council Application – Film and Media
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Section H – Presentation to the Public
NWT Arts Council requires you to give a public performance, screeing or exhibition of your completed project.
Venues do not have to be confirmed at this stage.
How do you intend to accomplish this? Examples: public performance at local school or community hall, film
launches, workshop delivery, public screenings, online presentations, radio or television broadcasts, etc.
Section I - Applicant’s Statement
I agree to acknowledge the financial assistance received from NWT Arts Council in all public presentations of
this project and by using the NWT Arts Council logo in ads and on all promotional materials.
I agree to provide copies of results of my work as part of final project reporting. These may include audio CDs,
mp3’s, online links and/or videos, photos of project, digital materials, news clippings or promotional materials.
I hereby certify that the information contained in this application is true and correct to the best of my knowledge
and belief, and that I do not have any outstanding commitments from previous projects financed by the NWT Arts
Council or the Government of the Northwest Territories.
_______________________________________________________
Applicant Signature
NWT Arts Council Application – Film and Media
_________________________
Date
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SECTION F SUPPLEMENT
List of Film and Media Support Material
Please provide three (3) film or media samples that will serve to introduce the NWT Arts Council to your art form.
Remember that it will be evaluated on artistic merit, so please submit the highest quality material you have
available.
The jury committee only has time to review 3 samples of 1 minute each, so please indicate where you would like
them to listen or view by filling in the time cues below.
Otherwise the jury committee will listen to or view the first 1 minute of the sample. It is the applicant’s
responsibility to ensure that the audio/video samples function properly.
Sample 1
Title: _________________________________________
Creation date: _____________
Producer: ____________________________ Artist(s):_________________________________________
Are these the same artists as proposed in the project? _____
Time Indicator: from___:____ to___:_____
Sample 2
Title: _________________________________________
Creation date: _____________
Producer: ____________________________ Artist(s):_________________________________________
Are these the same artists as proposed in the project? _____
Time Indicator: from___:____ to___:_____
Sample 3
Title: _________________________________________
Creation date: _____________
Producer: ____________________________ Artist(s):_________________________________________
Are these the same artists as proposed in the project? _____
Time Indicator: from___:____ to___:_____
NWT Arts Council Application – Film and Media
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