Grant Program for the Arts and Literature in the Outaouais Region

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1 Application form for artists Conseil des arts et des lettres du Québec Ville de Gatineau MRC des Collines, MRC de la Vallée-de-la-Gatineau, MRC de Papineau, MRC de Pontiac Support for professional artists and writers Identification of the applicant Mr Ms Name First name Artistic discipline Year artistic practice started Specialty or field Project summary Title Summary (30 words) Start date (yyyy/mm/dd) Completion date (yyyy/mm/dd) Does your project rely on digital technologies (excluding office automation tools, such as word processing)? Yes No Characteristics specific to your profile Up-and-coming artist or writer 35 years old or younger on the project registration date (please provide your birth date in the statistics section at the end of this form). Project financing Amount requested $ Other funding sources $ Total project cost $ Contents of the application file To complete your file, a single copy of the following documents is required: Duly completed and signed form. Curriculum vitæ of the applicant, participant artists and collaborators, if applicable. List of participants (participant artists, collaborators, freelancers, technicians, etc.). Press kit (maximum: 5 pages). Written confirmation of participant artists and collaborators participation, if applicable.

2 Supporting materials Five (5) copies of the following supporting documents identified with the applicant s name: For theatre, the circus arts and multidisciplinary arts: a recent work presented on a DVD or CD or a compilation of selected works lasting no more than 15 minutes. For dance: a maximum of three choreography segments lasting no more than 15 minutes recorded on a DVD. For music: a recent recording, in studio or in concert, of three works recorded on a DVD or CD. For the digital arts, visual arts, arts and crafts, film and video art and architectural research: a maximum of 15 digital images or a compilation of selected works lasting no more than 15 minutes presented on DVD or CD. For literature and storytelling: a book or manuscript excerpt of no more than 25 pages. A recent work or a compilation of selected works lasting no more than 15 minutes presented on a DVD or CD. Description of the supporting materials and documents (title, medium, year, dimensions, duration, place of public dissemination, etc.) Supporting documents must be presented on a DVD or CD, readable on a Windows environment, using one or more of the following software or plug-ins: Internet Explorer, version 10 or earlier. QuickTime version 7.7 or earlier - standard Macintosh video and audio format (.mov). Do not use an HD video format. Shockwave Player, up to version Windows Media Player, up to version 12. Flash Player, up to version 13. Acrobat Reader, up to version 11. VLC Media Player. For video, the recommended formats are MPEG 1 to 4, MOV and AVI. As for audio, the MP3 and M4A formats are suggested. If the supporting items and documents cannot be presented in keeping with the above recommendations, please contact the program officer responsible at the CALQ. The applicant is responsible for ensuring that all documents arrive intact and in the appropriate formats. The partners cannot be held responsible for any loss or damage resulting from the expedition or return of documents accompanying the application. We recommend that applicants avoid submitting the originals of works or documents to support the application. Applications sent by fax or will not be accepted. Only original copies of the application duly signed by the artist applicant will be considered valid. Incomplete applications and those submitted after the application deadline are not accepted. Pursuant to the dispositions of the Act respecting Access to documents held by public bodies and the Protection of personal information, the CALQ and its partners agree to respect the confidentiality of the documents and information in their possession as well as those transmitted to them. An applicant who changes address after submitting his application must notify the CALQ promptly to ensure that correspondence reaches him at his new address. Outaouais FOOU ( )

3 Project description Check the general objective(s) addressed by the project submitted. To identify the objective(s), please refer to the program brochure Check the specific objective(s) addressed by the project submitted. To identify the objective(s), please refer to the program brochure Describe the project for which financial support is requested, clarifying how it relates to the program s objectives (maximum of 500 words). Outaouais FOOU ( )

4 Detailed budget Provide a detailed, balanced budget enumerating all expenses to be incurred and the project s financing sources. The amount of the grant cannot exceed more than 80% of the project s total financing. Revenue $ Max. % Expenses $ Programme pour les arts et les lettres Partner no. 1 $ 80% $ % Creation expenses X month $ Honoraria X person X month/day/week $ Partner no. 2 $ % Equipment rental $ Partner no. 3 $ % Materials $ Sponsorship $ % Transportation X distance $ Independent funding sources $ % Promotion costs $ Total $ 100 % Total $ Comments: Outaouais FOOU ( )

5 Project timetable Describe the steps for realization of the project (maximum of 500 words). Outaouais FOOU ( )

6 Summary of the applicant s recent dissemination activities Nature of the activity Location of presentation Date realized Artistic approach (Maximum 500 words.) Outaouais FOOU ( )

7 Confirmation of the partner I confirm my knowledge of the project and I certify, in all good faith, that the information provided is accurate. Name of the partner organization Mr Ms Full name of person in charge Address Apartment City Province Postal code Telephone no. (work) ( ) -, ext. Telephone no. (other) ( ) - Website Signature of the person in charge Description of the commitment Identify the financial commitment or the value of services offered by the partner (work spaces, materials, specialized personnel, equipment or other), if applicable (maximum of 500 words). Outaouais FOOU ( )

8 This page is confidential and will be withdrawn during evaluation of the application. Commitment and consent Identification number To avoid administrative errors concerning the identity of grant applicants, the CALQ requests the 6th, 8th and 9th digits of your social insurance number (SIN). Please fill in the appropriate boxes. Mr Ms Street address First and last names (in block letters) XXX - XX - X No. Rue Apartment City Province Postal code Mailing address (if different from the street address) No. Rue Apartment City Province Postal code *** ***-**** Telephone (indicate the area code) *** ***-**** Telephone (work) Consent Website Should I obtain a grant to carry out this project, I, the undersigned, hereby consent to the submission by the CALQ to the Société de télédiffusion du Québec (Télé-Québec) of the following nominative information: my name, civic address, telephone number, address, the title and a description of my project and the anticipated date of its completion. This information will be submitted to Télé-Québec in order to foster better promotion on television or the Internet of the artistic and literary activities that the CALQ supports in all regions of Québec. Accordingly, I also agree that a representative of Télé-Québec may contact me directly in order to promote my project insofar as a television broadcaster selects the project. Yes No I have applied for another grant in respect of the same project. Yes Name of program Declaration of commitment No If so, from which organization? Application date In accordance with the general eligibility criteria governing the program, I hereby declare that: I am a Canadian citizen or a landed immigrant as contemplated in section 2(1) of the Immigration and Refugee Protection Act. I normally reside in Québec and more specifically have resided in the region concerned for at least 12 months. By submitting this grant application to the CALQ, I implicitly agree that the assessors or the members of the selection committee may have access to personal or confidential information about me, as defined in the Act respecting Access to documents held by public bodies and the Protection of personal information, insofar as such information is necessary to enable them to perform their duties. I authorize the CALQ to conduct the necessary verifications with other granting agencies to ensure that the funds granted in respect of this application do not cover any expense pertaining to a project already supported under a program of any other agency. If my project is selected and a grant is accorded to me, I accept that the program s financial partners may present a brief description of my project during the announcement of the financial assistance, if applicable. Yes No I agree to abide by the rules of the program as stipulated in the brochure and to comply with the decision of the financial partners, which is final and cannot be appealed. I also undertake to submit a detailed report on the use of the grant within three months after completion of the project. I hereby certify, in good faith, that the information provided is accurate and complete. Signature Date Outaouais FOOU ( )

9 General information for statistical purposes only Thank you for your collaboration in completing this questionnaire, which is intended to provide a socio-economic profile of artists in order for the CALQ to enhance its initiatives to assist artists. The information you provide is confidential and will be used for statistical purposes. This page will be withdrawn during the evaluation process. Demographic characteristics Mr Ms First and last names (in block letters) Date of birth (yyyy/mm/dd) Mother tongue French English Other (specify) Place of birth Québec Other province Other country (specify) To which ethnocultural group do you belong? French English Aboriginal Other (Arab, Chinese, etc.) Specify Professional characteristics Main occupation (check only one item) Professional artist or writer Teacher Other What artistic training do you have? Place of training Québec Other province Other country University degree Cegep diploma or equivalent Diploma from a public institution (conservatory, etc.) Diploma or certificate from a private arts school Training with one or more recognized artists Other art training (specify) Self-taught Have you participated in skills upgrading sessions in the past three years? Yes No Québec Other province France United States Other country (specify) Have you received any grants during the past three years? Yes No CALQ Canada Council for the Arts Other (specify) Please indicate your income category over the past year: Less than $20,000 $20,000 to $29,999 $30,000 to $39,999 $40,000 or more What proportion of your overall income results from your artistic activities? Less than 25% 25% to 49% 50% to 74% 75% or more During the past three years, has your work been disseminated outside Québec or have you participated in the promotion of works from Québec outside of Québec? Yes No Other province France United States Other country The masculine form used in this document is understood to designate men and women equally. Outaouais FOOU ( )

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