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SMALL GRANT PROGRAM APPLICATION <br />Five Wings Arts Council - PO Box 118 - Staples, MN 56479 <br />218 - 895 -5660 1- 877- 654 -2166 www.fwac.org fwac @arvig.net <br />This program is designed for first time organizational applicants or those organizations wishing to take <br />advantage of a new or late breaking opportunity which does not allow time to apply within our regular <br />Production/ Sponsorship grant cycle. <br />Deadline: Ongoing until funding is disbursed for year. Applications received by the 1st day of the month will <br />be reviewed that month. Applications received after the 15t day of the month will be reviewed the following <br />month. Only one successful grant application per organization per fiscal year. <br />Check the Appropriate Box: First Time Applicant Late Breaking or New Opportunity <br />1. Applicant Organization (Name, Address, Phone) <br />2. <br />Project Director (Name, Address, Day & Eve Phone) <br />City of Pequot Lakes <br />Dave Guenther <br />4638 County Road 11 - Pequot Lakes, MN 56472 <br />32832 County Road 39 - Pequot Lakes, MN <br />218 -568 -5222 <br />56472 - w:218 -568 -9252 h:218 -543 -4146 <br />E -Mail: mayor @pequotlakes- mn.gov <br />E -Mail: dguenther @isdl86.org <br />3. Date of IRS Tax - Exempt Letter N.A. <br />4. <br />Estimated Audience 10,000 <br />(First time applicants must include a copy of the letter). <br />Estimated Artists /Performers 30 <br />5. Fiscal Agent <br />6. <br />Project Budget Summary <br />(If Applicable. A Fiscal Agent Agreement must be <br />enclosed.) <br />Total Project Cost $ 600.00 <br />N.A. <br />Amount Requested $ 600.00 <br />Cannot exceed $1,000 <br />7. Brief Project Description <br />8. <br />Location of Activities <br />To design and paint a mural depicting a history of Pequot <br />north side of 30984 Government Drive <br />Lakes on the north side of the Pfeiffer Drug building <br />located in Pequot Lakes downtown on the corner of <br />03/15/12 <br />County Road 11 and Government Drive <br />9. <br />Project Starting Date <br />Project Ending Date 07/31/12 <br />10. Certification: We certify the information in this application is true and correct to the best of our knowledge. We also <br />give permission to the FWAC to use any or all information in this application for promotional purposes. <br />Project Director Dave Guenther <br />Name and Title Signature Date <br />Fiscal Agent N.A. <br />Name and Title Signature Date <br />