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2. Project Name*
3. Organization*
5. Contact Name(s)*
6. Email Address*
8. Contact Phone(s)*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Description of the Project *

    50 words or less

17. Describe the portion of the project for which you are requesting PAC Mini-Grant funds*

    50 words or less

19. Target Audience*
20. Total Amount Requested from PAC*

    Not to exceed $500

22. Date(s)*
    Date(s)
23. Time(s)*
    Time(s)
24. Location*
26. How will the project be publicized?*
28. NOTE:

    The PAC makes every effort to ensure that a representative will attend all events sponsored in part by PAC, so notification in writing of changes in date/time are required to be emailed to PublicArtsCommission@forestgrove-or.gov 72 hours in advance.  If the funded event does not occur as scheduled, the event must be rescheduled and completed within 30 days of the originally scheduled event or the grant will be forfeited.  

30. Projected Budget Total Estimated Costs*
32. Personnel (explain):*
34. PAC Mini-Grant*
35. Requesting Organization*
36. Other (specify)*
38. Marketing and Publicity (explain):*
40. PAC Mini-Grant*
41. Requesting Organization*
42. Other (specify)*
44. Materials and Supplies (explain):*
46. PAC Mini-Grant*
47. Requesting Organization*
48. Other (specify)*
50. In-Kind Contribution (explain):*
52. PAC Mini-Grant*
53. Requesting Organization*
54. Other (specify)*
56. PAC Mini-Grant TOTAL:*
57. Requesting Organization TOTAL:*
58. Other TOTAL*
60. Name of organizations the will partner or collaborate with this project*
62. Number of people in the community who are anticipated to participate in this project*
64. How will this project benefit the Forest Grove Community?*
66. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
67. Date
    Date
69. Electronic Signature
71. Requirements:

    Application needs to be submitted two weeks prior to a regular Public Arts Commission meeting (held on the 3rd Thursday of each month) to be considered.  Applicants should plan to attend the PAC meeting to present the application and answer questions.  

    Within 30 days of the funded event, the applicant is required to submit the Project Summary and Evaluation to City Hall, Attn. Jaime Zaik, @ jzaik@forestgrove-or.gov.  The report should include receipts, copies of publicity and photos, if available.  A reimbursement check, not to exceed the grant amount, will be processed two weeks after receipt of the Project Summary and Evaluation.  

    NOTE: Request for reimbursement and summary report must be received within 30 days of the completion of the event or the grant money will be returned to PAC general budget.  

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75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit

* indicates a required field