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PARTICIPATION Estimate the total number of people and the population <br /> CXARACTERISTICS groups to which they belong who ~111 be Involved collect- <br /> Ively in the Grassroots funded programs described in <br /> item 7. Speclal consideration should be given ~n planning <br /> your programs to the active Involvement of raclal and <br /> ethnic minorities and people wlth disabilltles. (These <br /> Participation Characteristics ~111 need to be provided <br /> in detail for each specific program in the Grassroots <br /> evaluation required at the end of the project period.) <br /> Paid Staff (full-tlme personnel) <br /> (part-time personnel)- <br /> Volunteers <br /> Artists 7 <br /> Audience 1500 <br /> (people benefitting from the <br /> project) <br /> Total Participation ]629 <br /> (complete statistics in each <br /> section below) <br /> <br /> Speclal Percentage Speclal Percentage <br /> Population of Total ~opulation ul ~uta~ <br /> Group' Participants Group Participants <br /> <br /> G General ~] ~G E Hentally or <br /> Psychologlcally <br /> N A~erican Indian/ impared 3 ~E <br /> Alaskan Native 2 ~N O Nearing Impared 0 ~D <br /> A Asian/Pacific Q Visually Impared 0 <br /> Islander 0 ~A P Otheralse Physi- <br /> B Black, not Nispanic 5 ~B rally impared 3 ~P <br /> H Hispanic 0 ~H I Institutionalized <br /> ~ ~hlte, not Hispanic . q3 ~/ (other than <br /> C Child 40 ~C correctional) 3 <br /> Y Secondary School J Institutionalized <br /> Student . 4~ ~Y (correctional) 0 ~J <br /> U C~llege/Unlversity V Veteran 5 ~V <br /> Student 5 ~U F ~oman 65 <br /> S Senior Citizen 10 <br /> <br />I0. CHECKLIST Please make sure the application i~ complete by following this <br /> checklist. Incomplete applications wl]l not be reviewed. <br /> <br /> x I. Applicant Organization information complete. <br /> X.~2. Operating Income section complete and fiscal infor~atlon attached in d~pllcate. <br /> ~x Income and expense statement for previous year. <br /> ___x Operating budget for current year. <br /> x Planned operating budget [or next year. <br /> _~3. Program Sugary complete and addition correct. <br /> .Z_q.~atchlng ~unds identified and certification letter attached if funds are <br /> being provided by another organization. <br /> x 5. Internal Operations narrative complete. <br /> j:_ 6. Comtnunlty Outreach narrative complete. <br /> jL_7. Program 0escriptlons complete0 and additional pages also submitted in duplicate. <br /> 8. Financia~ infor~atlon complete and addition correct. <br /> x ~. Participation Characteristics c~plete. <br /> <br /> <br />