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PARTICIPATION Estimate the total number of people and the population <br /> CNARACTERISTICS groups to which they belong who will be |nvolved collect- <br /> Ively in the Grassroots funded programs described In <br /> Item 7. Special consideration should be given In plannlng <br /> your programs to the active Involvement of racial and <br /> ethnic mlnorltIes and people with dlsabllltles. (These <br /> Participation Characteristics will need to be provided <br /> In detall for each specific program in the Grassroots <br /> evaluation required at the end of the project period.) <br /> Paid Staff (fu11-tlme personnel) 3 <br /> (part-time personnel)' <br /> Volunteers ~6 <br /> Artists ] <br /> Audience 2500 <br /> (people benefitting from th~ <br /> project) <br /> Total Participation 2520 <br /> (complete statlstlcs In each <br /> section below) <br /> <br /> Special Percentage Special Percentage <br /> Populatlon of Total Population of Total <br /> Group Participants Group Participants <br /> <br /> G General 50 ~G E Mentally or <br /> Psychologically <br /> N American Indian/ Impared 3 ~E <br /> <br /> Alaskan Native __~N D Nearing Impared 5 ~D <br /> A Asian/Pacific Q Visually Impared 5 ~Q <br /> Islander __ ~A P 0therv~ise Physi- -- <br /> B Black, not Ilispanic lO ~B cally impared 5 ~P <br /> H Nispanic iN I Instltutlonalized <br /> W White, not Hispanic ~0 ~' (other than <br /> C Child l0 ~C correctional) [I <br /> Y Secondary School J Institutionalized <br /> Student 10 ~Y (correctional) [J <br /> U College/University V Veteran 20 ~V <br /> Student 5 ~U F Woman 65 ~1~ <br /> S Senior Citizen 05 ~S <br /> <br />10. CHECKLIST Please make sure the application is complete by following this <br /> checklist. Incomplete applications will not be reviewed. <br /> <br /> 1. Appllcant Organization Information complete. <br /> 2. Operating Income section complete and fiscal Information attached In duplicate. <br /> Income and expense statement for previous year. <br /> __ Operating budget for current year. <br /> Planned operating budget for next year. <br /> 3. Program Summary complete and addition correct. <br /> --h. Matching funds identified and certification letter attached if funds are <br /> being provided by another organization. <br /> 5. Internal Operations narrative complete. <br /> --6. Cora~unity Outreach narrative complete. <br /> -- 7- Program 0ascriptions complete, and additional pages also submitted In duplicate <br /> --8. Financial information complete and addition correct. <br /> __9. Participation Characteristics complete. <br /> <br /> <br />