Project Application Form

Project Application Form INSTRUCTIONS Please fill out this form to present your project for consideration. Applications are accepted on an ongoing basis. We will be in touch with you as soon as possible or no later than 3 weeks after our next intake deadline. Each year, our deadlines are January 15, August 1, May 1, and November 1.  I confirm that this is not an application for funding and that I understand that ArtsPond Ventures is not a funding body. Signed

Date

APPLICANT INFORMATION Legal Individual Name OR Legal Organization/Collective Name Public Name (if different) Preferred Language

Written:  English  French Verbal:  English  French

First-time applicant to ArtsPond Ventures?  Yes  No Have you completed the activity for your previous project and attained a satisfactory final report?  Yes  No  Not applicable Legal Status

Unincorporated Incorporated

 Individual  Collective (Ad Hoc)  Non-Profit  Registered Charity  For-Profit

Incorporation Date Business Number Fiscal Year Ending (MMM/DD)

GST/HST Number

If your project is not a registered charity, have you ever applied to the Canadian Revenue Agency to become one?  Yes  No If Yes, When? What was the outcome? Career Level

 Amateur  Student  Pre-Professional  Emerging  Mid-Career  Established  Senior

Practice

 Creator  Performer  Curator  Impressario  Educator  Producer  Manager  Other (describe, max 30 words):

Discipline

Crafts Visual Arts Performing Arts

 Beadwork  Book Arts  Ceramics  Fibre Arts  Furniture  Glass  Jewellery Making  Metal  Tapestry  Textile Art  Wood  Drawing/Illustration  Installation  Mixed Media  Painting  Photography  Printmaking  Sculpture  Dance  Music  Opera/Musical Theatre  Theatre  Circus Arts  Comedy Theatre  Puppetry  Storytelling/Spoken Word  Animation  Film/Video  New Media  Screenwriting/Screenplays  Children’s Lit  Novels  Playwrighting  Poetry  Short Stories  Multidisciplinary  Interdisciplinary  Performance Art  Community Art

Media Arts Literary Arts Integrated Arts Other (describe, max 30 words):

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CONTACT INFORMATION Contact Name Contact Title Suite/Apt/Floor Number & Street Name Province Postal Code Phone Cell Fax Website Skype Facetime Twitter Facebook Other Social Media (describe):

R.R. #

City Postal Station Email Google+ Instagram

PROJECT DESCRIPTION Title Focus

 Creation  Curation  Exhibition  Presentation  Performance  Education  Other (describe, max 30 words)

Range

 Municipal (in your home municipality)  Regional (within 100 kms of your home municipality) Please list participating municipalities.

 Provincial (in your home province, more than 100 kms from your home municipality) Please list participating regions or municipalities.

National  Western Canada  Central Canada  Eastern Canada  Northern Canada  AB  BC  MB  NF  NS  NT  NU  ON  PE  SK  QC  YK Please list participating municipalities in each province or region.

International

 West USA  Midwest USA  Southwest USA  Southeast USA  Northeast USA  Mexico  Central America  Caribbean  South America  Europe  Africa  South Asia  Northeast Asia  Southeast Asia & the Pacific Please list participating cities and countries.

 Other (describe, max 100 words)

Projected start date Projected end date Short description (max 35 words) What is your project’s vision, mission and mandate? (max 500 words) What are the goals or purposes of your project? (max 250 words) What activities do you undertake to achieve these goals? (max 250 words) How does the project fit with ArtsPond’s mission and focus areas? (max 250 words) Why does your project want to be a part of ArtsPond’s shared charitable venture platform? (max 250 words)

ArtsPond Ventures, Project Application Form V 2.1, April 21, 2015

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What is the project timeline? Provide a brief schedule including planning, implementation, evaluation and reporting (date, activity/milestone type and description). Who is your intended audience? (max 250 words) List the key individuals necessary for the project (name, position). Indicate whether each role is part-time (P), fulltime (F), or volunteer (V). If selected to be a project, please list the individuals (name, areas of expertise) that would form the project’s Steering Committee. Your project Steering Committee works closely with ArtsPond’s Staff and Board of Directors to manage, evaluate and report on the success of the project. How did you hear about ArtsPond?  Word-of-mouth  Website  Facebook  Twitter  Other (describe): Any additional information? (max 500 words) FINANCIAL INFORMATION What is the project’s forecasted budget for the next year? Add additional rows with a description under each caterogry where necessary. REVENUES Earned revenues Private sector revenues Public Sector revenues Total revenues

Confirmed? Projected? 0 0 0 0

EXPENSES Artistic fees and salaries Production fees and salaries Programming expenses Facility expenses Fundraising expenses Marketing expenses Management fees and salaries Administration expenses Total Expenses

0 0 0 0 0 0 0 0 0

SURPLUS/DEFICIT

0

Does your project still require additional resources for any of the following?  Creation  Production  Education  Outreach  Touring  Marketing  Fundraising  Administration  Strategic Planning  Audience Development  Facilities  Insurance Other (describe):


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SUPPORT MATERIAL  Link to video (max 5 minutes) or image set (max 10) on YouTube, Vimeo, Flickr, or other online host  Curriculum vitae or résumé of one or two key individuals responsible for this project  Financial statement for the last fiscal year, if available  Annual report, press kit, newsletter, other print material in PDF format only (max 8 pages)


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