Appendix I Geographic Location.pdf

OMB #: 3135-0112

Expires 11/30/10

Rev. 10/30/08

GEOGRAPHIC LOCATION OF PROJECT ACTIVITY

Instructions: To assist the Arts Endowment in reporting to Congress on the geographic location of grant-supported activities, complete and return one copy of this form (via mail or fax) to the address below within 30 days of receiving your award letter or with your first payment request, whichever comes first. No grant funds will be released until this information is received.

Grants & Contracts Office/Geographic Location Project FAX: 202-682-5609/5610 National Endowment for the Arts 1100 Pennsylvania Ave., NW, Room 618, Washington, DC, 20506

Grantee Name: Grant # Address: Award Amount: $

Note: In responding to the following, provide information about places where grant-supported activities will occur during the grant period (including areas reached through touring, broadcast, etc.), not places from which audiences may be drawn. If you have questions about this form, please call 202/682-5424.

A. Check the one item that best describes where project activity for this grant will take place:

In one city/county.

In more than one city/county but within one State (include State-wide activity).

In more than one State but within the same metropolitan area (e.g., New York City/New Jersey).

In more than one State/metro area, but within the same geographic region (e.g., Western States).

In more than one State and more than one geographic region (include nationwide activity).

Outside the United States and its jurisdictions.

B. Based on current knowledge, list locations where project activity for this grant will take place, including the complete address (street/city/state/Zip+4) for each venue. Note that the full Zip+4 must be provided; for assistance with Zip Codes, go to http://zip4.usps.com/zip4/welcome.jsp. Follow the sample format (provided on the next page) or attach any similar listing of project activities and their locations.

GRANTEE RESPONSE:

Attach separate sheet(s) as necessary, indicating grantee name and grant number at the top of each page.

Activity Title and/or Type Activity Date(s) Location(s) [Name & address; Zip+4 required.]

C. Contact Person for further geographic location information (please print or type):

Name: Telephone:

Title: E-mail:

http://zip4.usps.com/zip4/welcome.jsp

Geographic Location of Project Activity

SAMPLE FORMAT

Activity Title and/or Type Activity Date(s) Location(s) [Name & Address; Include Zip+4]

Ex. 1 Performance by Lone Star Dance Company (full company)

9/1/08 Paramount Theatre 713 Congress Ave.

Austin, TX 78701-3216

In-school lecture/demo by choreographer J. Smith and Lone Star Dance Company (touring ensemble)

10/08 Audie Murphy Middle School 53393 Sun Dance Dr.

Ft. Hood, TX 76544-4001

Additional school (TBA) Ft. Hood, TX

Ex. 2 Art Today traveling exhibition Sept.- Dec. ‘08 San Francisco State University Art Museum

1600 Holloway Ave.

San Francisco, CA 94132-1722

March – July ‘09 Seattle Art Museum

1300 First Ave.

Seattle, WA 98101-2003

Ex. 3 New Jazz radio broadcasts 2009 WNYC (New York, NY)

WWUH (West Hartford, CT) WVPS (Burlington, VT)

(Alternatively, attach a station carriage list.)