This is a text (HTML) version of the PCAC Arts in the Schools grant application form. You can print it out and use it as a mail-in form. (Click here to download a one-page PDF version of this form.)

In order for your application to be reviewed, this form must be completed in full and mailed to:
Pleasanton Cultural Arts Council, P.O. Box 1298, Pleasanton, CA 94566, postmarked no later than January 15, 2010.

Name of School: _______________________________________________________________________________________

Address: ______________________________________________________________________________________________

Telephone: ___________________________________________________________________________________________

E-mail: _______________________________________________________________________________________________

Contact Person: _______________________________________________________________________________________

Site Director/Principal: _________________________________________________________________________________

Program/Sub Agency: __________________________________________________________________________________

Title of Project: _______________________________________________________________________________________

Name of individual or group providing service: ____________________________________________________________

Artist Fee: $_______________________

Miscellaneous Fee: $_______________________

Date Funds Needed: ____/____/____

How much are you requesting from the PCAC? $_______________________

What is the source of your matching funds for the PCAC grant? ____________________________________________

Check here if applying for the Golden Apple $200 grant: ____

What is the source for your Golden Apple matching funds? _______________________________________________

Description of project: ________________________________________________________________________________

Student audience summary: ___________________________________________________________________________

Please quantify number of students served, cost per student: ____________________________________________

For cultural activities, identify audience served, participants, age groups, etc.: _____________________________

Do you coordinate your efforts with any other organization(s) addressing the same need? If so, list the name(s) of the organization(s): ________________________________________________________________________________________

Please state how you plan to evaluate the success of the program/project being proposed (methods used):

______________________________________________________________________________________________________

How much does your school spend on the Arts? I.e. SIP, PTA, etc.: $_______________________

Signatures: When you sign this form, you are stating that you have prepared this Grant Request and the School Director/Principal is in full knowledge of this request.

Contact Person/Title: _________________________________________________________________________________

Site Director/Principal: ________________________________________________________________________________

Date: ____/____/____