13 CAR pt. 62, Appendix A
Organization Name: ______
| DAH REQUEST | APPLICANT SHARE | TOTAL PROPOSED BUDGET | |
|---|---|---|---|
| INCOME | |||
| Earned Revenue | |||
| Private Contributions (cash support) | |||
| Corporate Contributions | |||
| Foundation Grants | |||
| Government Support (city) | |||
| Government Support (county) | |||
| Government Support (state – DAH Request) | |||
| Government Support (other state – explain on additional sheet) | |||
| Government Support (regional) | |||
| Government Support (federal) | |||
| TOTAL INCOME | |||
| In-Kind Contributions | |||
| EXPENSES | |||
| Staff salaries/benefits | |||
| Contracted Programming Personnel | |||
| Marketing/Public Relations | |||
| Production Supplies/Materials | |||
| Artist Fees | |||
| Shipping | |||
| Construction/Installation | |||
| Travel | |||
| Rentals/Maintenance | |||
| Remaining Expenses (explain on additional sheet) | |||
| TOTAL EXPENSES | |||
| Surplus (deficit) |