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2. Date
   Date
3. Application Due Date

   This Application is due on July 21, or following Monday if this date falls on a weekend. Applications received after this date will not be considered for the upcoming fiscal year.

5. First Name*
6. Last Name*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number
15. Email Address
17. Project Title*
19. Brief Description of the Project*

    Provide a brief description of the project -- the basic Who, What, Where, When, and How needed for us to understand what your project is about and how it can be implemented.

21. Benefit to the Community*

    Describe the benefits of your project to the community. Provide information about Return on Investment, such as cost savings or leveraging funds with other projects. Estimate the number of people served and the number of participants. Discuss outcomes and impact.

23. Potential/Actual Partners (OPTIONAL)

    List the community partners (people and/or organizations) needed to make your project successful, and state whether they have agreed to assist or if you have yet to discuss the project with them.

25. Timeline*

    Project Start Date: No earlier than December 1

    Project End Date: No later than August 15

    Timeline details should include at a minimum the month and brief description of the activities. For example:

    * December: Create flyer and begin marketing

    * January: Hold four workshops. Collect evaluation cards. 

    * February: Complete required report and submit to the City of Smithville.

27. Project Cost Information

    What is the total cost of the project? 
    How much are you requesting from the Smithville Cultural District? 
    How much are you providing in match?

    NOTE 1: All projects will require NO LESS THAN 10% match.

    NOTE 2: The Cultural District has a very limited amount of funds. Projects over $5,000 are highly unlikely to be funded. Projects under $2,000 are more likely to be feasible.

29. Total Project Cost*
30. Cultural District Request*
31. Match (no less than 10%)*
33. Matching / Sponsorship Information*

    Be as specific as possible with the names of the people and/or organizations you've contacted to request sponsorship funds for the match requirements. State whether they have confirmed that they will provide the match or if you are proposing to reach out to them. If you will seek sponsors, describe briefly what your plan is to reach out to them.

35. Previous City Grants*

    1. Yes
    2. No

    Click "Yes" if you have received a grant from the City of Smithville's Cultural District within the past two years.

37. Acknowledgement of Reporting Requirements*

    1. I understand that I must submit a report to the City of Smithville no later than August 15.

    Check here to acknowledge that you must submit a report by August 15

39. Instructions

    Submit this application as directed.

    Download the Excel Budget sheet and email your budget to Jill Strube per instructions on the webpage.

    These two documents are required for the application to be considered complete.

    An optional one-page letter that explains your project in more detail is also allowed. Send by email to Jill Strube if you opt to write one. Only the first page will be considered. Do not send a PowerPoint presentation. A Word or PDF file is acceptable.

Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field