Cover Page Grant Type (check one): Mini-Grant Major Grant Project Title: Sponsoring Organization: Website: Tax ID Number/EIN (if applicable): DUNS Number (required): SAM.gov (System for Award Management) active registration: Yes No Pending Project Director: Fiscal Agent: Brief Project Description: Budget Totals: WHC Funds Requested Matching Funds Total Legislative Districts (please provide district numbers): County US Congressional State Senate State Assembly
Calendar of Events: City or Town County Date and Time Project Termination Date: Estimated Audience Size:
Certifications The Applicant hereby certifies to the WHC that: 1. The submission of this proposal has been authorized by the governing body of the applicant organization or group, and the Project Director and Fiscal Agent listed are authorized to act as the representatives of the applicant in connection with this proposal. 2. The applicant organization or group is constituted for nonprofit reasons. 3. Any funds granted as a result of this proposal will be administered in accordance with all guidelines and provisions of the Wisconsin Humanities Council and the National Endowment for the Humanities. 4. The applicant organization or group has not been debarred from receiving federal funds and is in compliance with non-discrimination statutes. 5. The applicant organization or group certifies the participation of project personnel identified and described in the attached project personnel forms. Project Director Signature: Date: Fiscal Agent Signature: Date: May the WHC use the Project Director's email address in our calendar of events? Yes No Payee Checks are payable only to the sponsoring organization, not to individuals. Checks are mailed to the person designated as the payee: One copy of this form must include original signatures.
Project Description Please answer all seven parts. Limit your answers to the spaces provided. 1. Describe the sponsoring organization: its mission, activities, and public programs. Cite any past experience with the WHC. 2. Describe your project. Include research, planning, and public programs. In your descriptions, please address the following: Provide a preview of the subject matter you will be sharing with participants. Help us understand the ideas your project explores. What are two or three of the key questions that your project addresses? What format and venue will you use for your public program(s)? How will this format help your participants engage with the subject matter?
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3. Why is your organization developing this project? What need or interest in the community are you intending to address? What goals have you set for the project? 4. Who is your intended audience? Why? How do you intend to publicize the project?
5. Describe the organizations with which you are collaborating on this project and why. What are their roles? Cite established or new organizational partnerships. 6. List the names and affiliations of your humanities expert(s) and briefly summarize the roles they will play in your project. Use the required project personnel forms to provide details for each humanities expert, the Project Director, and other key personnel.
7. How will you evaluate the impacts of your project on your audience, participants, and partners? What kinds of feedback will you collect and how will you use it? What outcomes do you anticipate within the community and in your organization as a result of the project?
WISCONSIN HUMANITIES COUNCIL GRANT BUDGET FORM WHC REQUEST MATCHING FUNDS TOTAL PERSONNEL Administrative Personnel (list by name): Project Director: Frank Simmons, Curator, 6% x 9 months 0.00 2,430.00 2,430.00 Fiscal Agent: Janet Brown, Director, 1% x 9 months 0.00 540.00 540.00 Administrative Support: Samantha Smith, Project Assistant, 160 hours @ $10.00 0.00 1,600.00 1,600.00 Program Personnel (list by name): Historian: Dr. Charlene Alma, UW-Bucky, 2 days plan/review @ $200 400.00 0.00 400.00 Educator: Dan Johnson, Anytown High School, 2 days plan/review @ $200 400.00 0.00 400.00 Exhibit Designer: Tania Belmont, 225 hrs @ $20 3,550.00 950.00 4,500.00 In-Kind Support: Anytown Museum volunteers, Anytown High School students 0.00 16,800.00 16,800.00 1680 hours @ $10.00 TRAVEL, FOOD, and LODGING School Bus (Anytown High School AP History students): 2 trips @ $300 600.00 0.00 600.00 Miscellaneous Mileage (Anytown Museum staff/volunteers): 500 miles @ $.51 77.00 178.00 255.00 HOSPITALITY N/A 0.00 0.00 0.00 SUPPLIES and SERVICES Supplies (construction): gallery exhibits (3); panels (12); kiosks (3) 4,354.00 3,584.00 7,938.00 Duplicating & printing: participant packets (45); flyers (1500 x 3) 319.00 401.00 720.00 Telecommunications: N/A 0.00 0.00 0.00 Postage: Bulk mailings ($1,100 x 3); first class (100) 0.00 441.00 441.00 Equipment Rental: N/A 0.00 0.00 0.00 Promotion: Print (10 two-column, Anytown Journal ); Broadcast (10 one min., WKRP) 300.00 1,475.00 1,775.00 Facility Rental: N/A 0.00 0.00 0.00 Other: Office supplies; transcription (6 interviews x 4 hrs @ $16) 0.00 388.00 388.00 INDIRECT COSTS WHC Does Not Pay Indirect or Overhead Costs 0.00 0.00 TOTALS (Transfer Totals to Cover Page) 10,000.00 28,787.00 38,787.00 Please remember that the applicant must assume at least 50% of the total cost of the project, which may include in-kind support.
Budget Description Explain key details of your budget in the space below. Consult instructions for more information.
Project Personnel Form (add additional forms as needed) Complete individual forms for the Project Director, each humanities expert, and other key personnel. Personnel: Job Title & Organization: 1. Education: Describe field of study, institution, including degrees, if any. 2. Describe the particular background and research interests that qualify this person as a resource for the program. 3. Describe the specific role of this person in the proposed project. Pay particular attention to how the participating humanities scholars will use their humanities expertise.
Project Personnel Form Complete individual forms for the Project Director, each humanities expert, and other key personnel. Personnel: Job Title & Organization: 1. Education: Describe field of study, institution, including degrees, if any. 2. Describe the particular background and research interests that qualify this person as a resource for the program. 3. Describe the specific role of this person in the proposed project. Pay particular attention to how the participating humanities scholars will use their humanities expertise.
Project Personnel Form Complete individual forms for the Project Director, each humanities expert, and other key personnel. Personnel: Job Title & Organization: 1. Education: Describe field of study, institution, including degrees, if any. 2. Describe the particular background and research interests that qualify this person as a resource for the program. 3. Describe the specific role of this person in the proposed project. Pay particular attention to how the participating humanities scholars will use their humanities expertise.