Appendix F Consortium Form.pdf
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- Solicitation number
- NEARFP10-04
- Issued by
-
National Endowment for the Arts
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Grants for Arts Projects Application Consortium Partner Information (For official Consortium Applications only)
Read the instructions for this form before you start.
OMB No. 3135-0112 Expires 11/30/07
To be completed only by the one primary consortium partner and included in the application package. Do not complete this form if you are applying for a Challenge America Fast-Track Review Grant.
Lead Applicant for Consortium (official IRS name):
Primary Consortium Partner’s IRS name:
Popular name (if different):
Primary Consortium Partner’s Authorizing Official
Mr. Ms. First: Last:
Address:
City/State/Zip Code (9-digit number):
Taxpayer ID Number (9-digit number):
Web Address: http://
Contact: Mr. Ms. First: Last:
Title:
E-mail:
Telephone:
ext.
Fax:
Organization’s Total Operating Expenses for the most recently completed fiscal year (unaudited figures are acceptable): $
Mission/purpose of your organization:
Briefly describe your organization’s involvement in planning and executing the consortium project including programming, management, finances, and any responsibilities for matching the Arts Endowment’s grant. Be specific; do not provide a general statement of support for the project. Use this space only.
| Applicant name: |
| Partner's name: |
| Partner's popular name: |
| Partner: Mr: Off |
| Partner: Ms: Off |
| Partner First name: |
| Partner Last name: |
| Street address: |
| City/state/zip: |
| Partner Tax ID 1: |
| Partner Tax ID 2: |
| Partner Web address: |
| Contact: Mr: Off |
| Contact: Ms: Off |
| Contact First name: |
| Contact Last name: |
| Contact Title: |
| Contact email: |
| Contact Area Code: |
| Contact Phone number: |
| Contact Phone extension: |
| Contact Fax Area Code: |
| Contact Fax number: |
| Total organizational operating expenses for the most recently completed fiscal year:: |
| Partner Mission: |
| Project involvement: |
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