Formulaire de demande d'aide financière - French American ...
Formulaire de demande d'aide financière - French American ...
Formulaire de demande d'aide financière - French American ...
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Application for Funding<br />
<strong>Formulaire</strong> <strong>de</strong> <strong>de</strong>man<strong>de</strong> d’ai<strong>de</strong> <strong>financière</strong><br />
Deadline for application is March 1 st<br />
La date <strong>de</strong> remise du dossier est le 1 er mars<br />
Applicant Candidat<br />
Name of the nonprofit institution Nom <strong>de</strong> l’institution à but non-lucratif<br />
Name and title of the person in charge of the project Nom et titre <strong>de</strong> la personne responsable du projet<br />
Address Adresse<br />
Telephone Téléphone Fax Télécopie<br />
E-mail Courriel Website Site web<br />
Institution Type Type d’institution<br />
Please return by mail to:<br />
The <strong>French</strong>-<strong>American</strong> Fund for Contemporary Music<br />
972 Fifth Avenue<br />
New York, NY 10075<br />
For questions contact:<br />
T. 212 439 1448 F. 212 439 1460<br />
e-mail: contemporarymusic@facecouncil.org<br />
Presenter Salle Festival Festival University, conservatory Univeristé, conservatoire Ensemble Orchestre<br />
Other Autre<br />
Project Title Intitulé du projet<br />
... .. ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ...<br />
Exact Project Dates Dates exactes du projet ( dd / mm / yy )<br />
Name(s) of the artist(s) Nom du (<strong>de</strong>s) artiste(s)<br />
Project Categories Catégories<br />
Production of a concert Production <strong>de</strong> concert<br />
Commission for new work Commission<br />
Tour Tournée<br />
Resi<strong>de</strong>ncy: composer, musician Rési<strong>de</strong>nce d’un compositeur, musicien<br />
Other Autre .. ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ...<br />
Summary of Project Présentation du projet<br />
Please attach a <strong>de</strong>tailed typewritten <strong>de</strong>scription, along with any material available, such as an audio recording, vi<strong>de</strong>o, or score. If return of materials is<br />
requested, a self-addressed stamped envelope (with sufficient postage) must accompany the application.<br />
Veuillez joindre une <strong>de</strong>scription détaillée, dactylographiée, et en anglais, accompagnée d'un dossier artistique - enregistrement, ou vidéo, partition, etc.<br />
Joindre une enveloppe dûement affranchie pour couvrir les frais <strong>de</strong> re-expédition du dossier si nécessaire.
Budget<br />
Please attach a complete overall project budget.<br />
Veuillez joindre le budget total équilibré du projet.<br />
Detailled budget must inclu<strong>de</strong> Budget détaillé doit inclure<br />
Expenses dépenses<br />
Production Cost Coût <strong>de</strong> production<br />
Freight Frêt<br />
Artist fees Cachets<br />
Travel Voyage<br />
Per diem of the artists Per diem <strong>de</strong>s artistes<br />
Other Autre<br />
Amount Montant<br />
Funding Requested Soutien <strong>de</strong>mandé<br />
Amount of funding requested from the Fund (not to exceed 50% of the total budget)<br />
Somme <strong>de</strong>mandée au Fonds (ne <strong>de</strong>vant pas excé<strong>de</strong>r 50% du budget)<br />
Agreement Contrat<br />
Name and title of the person qualified to sign a grant agreement with FACE (<strong>French</strong> <strong>American</strong> Cultural Exchange)<br />
Nom et titre <strong>de</strong> la personne habilitée à signer une convention avec FACE<br />
Grants payable to<br />
Règlement à établir à l’ordre <strong>de</strong><br />
... .. ... ... ... ... ... ... ...<br />
N.B. Grant amounts are allocated in US Dollars. Les montants <strong>de</strong>s bourses sont attribués en US Dollars, et seront converti en euros au<br />
moment du règlement par chèque pour les récipiendiaires français.<br />
Incomplete applications will not be consi<strong>de</strong>red.<br />
For the return of your materials, a stamped self-addressed envelope must accompany the application.<br />
Les dossiers incomplets ne seront pas étudiés.<br />
Y joindre une enveloppe suffisamment affranchie, pour couvrir les frais <strong>de</strong> re-expédition du dossier.<br />
How did you learn of the Fund? Comment avez-vous pris connaissance <strong>de</strong>s activités du fonds?<br />
Income recettes<br />
Box Office Ventes <strong>de</strong> billets<br />
Complementary financial support from the structure<br />
Apport complémentaire <strong>de</strong> la structure<br />
Other Financial Support Autres sources <strong>de</strong> financement<br />
Amount Montant<br />
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...<br />
In the name of my organization, I, the un<strong>de</strong>rsigned, will not hold the FACE responsible for the damage or loss of any documents or materials<br />
submitted with this application. I also agree to mention the support of the <strong>French</strong>-<strong>American</strong> Fund for Contemporary Music and other funding<br />
sources indicated by the Fund, on all communication materials concerning this project.<br />
Je soussigné(e), déclare, au nom <strong>de</strong> mon institution, assurer la responsabilité <strong>de</strong>s pièces confiées a FACE et ne saurais rendre celui-ci<br />
responsable en cas <strong>de</strong> perte, vol ou dégradation du dossier. Je m’engage, par ailleurs, à faire état <strong>de</strong> l’ai<strong>de</strong> accordée par <strong>French</strong>-<strong>American</strong><br />
Fund for Contemporary Music ou d’autres sources <strong>de</strong> financement indiquées par le fonds, sur tout support écrit relatif à ce projet.<br />
Date ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Signature ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...<br />
... .. ... ... ... ... ... ... ...
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