This sample application was taken from the Massachusetts Cultural Council grant application. The submitted application need not look exactly like this, but should contain the same information.

Submission date:

Applicant Information

• Applicant name:
• Applicant name also known as:
• Address:
• Mailing Address (if different):
• City/State/Zip:
• Chairperson (name, title):
• Executive Director (name, title):
• Project contact (name, title):
• Daytime telephone:
• Fax:
• Summarize the mission of your organization:
• Last fiscal year total income:
• Last fiscal year total expenses:

Project Information

• Title of project:
• Summary of proposed project:
• Project start date:
• Project end date:
• Number of individuals directly participating in/benefitting from this project:

Amount Requested:

Authorized Signature:

The signature below is that of the person authorized to testify as to the accuracy of this application (signature/title/date):