Name of Arts Organization or Cultural Group* Contact Person* First Last Contact Person Title Organization's Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email Website (if applicable) Organization's Social Media Profiles (ex. Instagram @sanbenitoarts_; FB @sanbenitoarts; #sanbenitoarts) Links to relevant videos, news articles and/or photo galleries (please separate links with a semicolon) AboutDescribe the makeup of your organization or group. Please describe how your organization or group is governed (i.e. paid staff, board, community volunteers) and how decisions are made. What are your primary programs and services?*Communities ServedDescribe the communities your organization serves. How does your organization represent and serve communities of color? Please describe how your organization, mission and leadership are deeply rooted and reflective of the identified community or group? How are your programs and services responsive and culturally-relevant to the identified group?*COVID ImpactDescribe how your organization, programs and services have been impacted by COVID. Please include a financial narrative of how COVID has affected your ability to fund staff, facilities, programs and services. What are your short- and long-term financial concerns?*Grant Funding Request Amount (maximun $4,000)* Describe how grant funds will be used.*ConfirmationSignature of Applicant* Today's Date* MM slash DD slash YYYY Acceptance:* By clicking this box you are stating that all information you have provided is true to the best of your knowledge and that the signature above is indeed you Δ