ICA Americans Recovery and Reinvestment Act Guidelines

Idaho Commission on the Arts ORGANIZATION APPLICATION FORM ARRA Applicants should read the guideline instructions before completing this form. Form can be handwritten or typed in 12-point font. Fill in all fields. Applicant/Organization (IRS name) _____________________________________________ Contact Name and Title_______________________________________________________ Street Address _____________________________________________ PO Box _________ City__________________________________State______Zip_________County ___________ Phone-Day-_______________________________Fax_____________________________ E-mail__________________________________Web-site_____________________________ This is a new address or phone number. Applicant is acting as a Fiscal Agent (see page 6) Period of support: Start Date_______________ End Date ____________  U.S. Congressional District 1 OR District 2  Legislative District ___________ Number of years doing business in Idaho ______Federal Tax ID# ________________ (required) In a one-page, narrative, describe how you will use these funds and their match. Attach to application form and budget form. If you have received a grant, did you submit the required final report? yes no Authorizing Signatures - I certify that the information contained in this application, including attachments and support materials, is true and correct to the best of my knowledge. I have read and agree to comply with the Legal Requirements of accepting this grant. __________________________________________________________________________ Authorized Staff/Project Coordinator Date __________________________________________________________________________ Financial Officer Date __________________________________________________________________________ Authorizing Official (person able to legally obligate the applicant) Date

Idaho Commission on the Arts 2410 Old Penitentiary Road Boise, Idaho 83712 www.arts.idaho.gov