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m <br />Please eslirna~e ihe arnounl of Grassroots funds requesled which <br />would bE ~penl on this projecl(s) during each quartet. <br />januar).k, larc. h $ 223.75 April-June $ 223.75 <br />Jul) Sept S Z;~3.~-clober-December~Z~ <br /> <br />12. DiscusSion with Arts Council <br /> <br />~Ae ha~e discussed ihls proposal v, iih <br /> <br />Local a,us to u rkcil liLapplica hie): <br />name I- t'arm lO~ll 1 n <br />~ille Executive Director <br /> <br />h;orth Ca~ollna Arts CounCil: <br />Name <br />fide <br /> <br />13. Checkli~ <br /> App[icanllnformationcomplele <br /> X Projecl(s) Summarycomplete <br /> X Projecl Descriptions complele for each project <br /> Discipline and Type of Aciivity Codes correct <br /> Projecl Budgets complete~'or each project <br /> Attachments complete <br /> Local arcs councilcontacted (if applicable) <br /> North Carolina Arts Council ~omrnunily Develop- <br /> ment Section contacted <br /> Certificalion signatures complete <br /> __Duplicate copies submilted to North Cato)ina Arts <br /> Council <br /> <br />14. Compliance Regulations <br /> · <br />Organizations recei~ lng North Carolina Arts Cound) suppor~ must <br />conduct their operalions in accordance with the requirements of <br />Tide VI of the CMl Rights Ac~ of 1964. Seclion 504 of the <br />Rehabililadon Act of 19F3, and, where applicable, lille IX of the <br />Education Amendmenls of 1972. which bar discrimination on the · <br />basis of race, color, nali0nal origin, handlcap,or sex. Organizaiioos <br />must also compl:,, with Ihe Fair Labor Standards Ac( which provides <br />minimum compensation to emplo),ees and must manage anyfunds <br />~eceived in accordance wilh O,',4 B Circular A-102 I'or administrative <br />requhements and v, iIh the applicable one of the follov,'ing OMB <br />circu)ars on cost principles: A-87 for state andloca)governments,A- <br />122 for non.~rofi~ organizations, or A-21 ~o~' colleges and <br />universities. <br /> <br />15. Ce~l'icatJon <br /> <br />We understand that failure to respondto an¥of tbo aboveltems may <br />seriously hinder ~he consideration of this application. We certify <br />t hat we are commin ed lo t he completion of the proposed projecl(s) <br />and thai Ihe information containedin this application including all <br />attachmenls and supporting maledals is true and cor ~ect to the best <br />of our knowledge. <br /> <br />Signature of \utho~izing Official Date <br />Ii,em B in Applicant Information above) <br /> <br />S~§nalure of Projecl Dheclor Dale <br /> <br /> <br />