PART I - SUMMARY INFORMATION NAME(Individual)_______________________________________________________________ Mailing Address_______________________________________________________ City ________________________ Province___________ Postal Code________ Telephone: Home (     )_________ Business (     )_______ Fax (     )________ NAME OF CONTACT PERSON___________________________________________ Mailing Address________________________________________________________ City _______________________ Province____________ Postal Code________ Telephone: Home (     )_________ Business (     )________ Fax (     )________ PROJECT PERIOD  _________                    ___________                                      Start Date (D/M/Y)      End Date(D/M/Y) INDIVIDUAL: Resident of Saskatchewan for One Year ___Yes ___ No BRIEF DESCRIPTION OF PROJECT: (3-5 sentences describing your objectives, the need for and benefits of the project, timetable and personnel responsible)           AMOUNT REQUESTED: ________________________ * must not exceed $750 PART II - INDIVIDUAL PROFILE DESCRIPTION OF THE INDIVIDUAL: (Provide a description of dance experience and dance qualifications. List any dance-related awards and distinctions).             PROJECTS WITHIN THE PAST TWO YEARS (Please describe projects successfully undertaken in the last two years, and specifically those which relate to the project for which you are seeking funding in this grant period.)             REFERENCES: (Please provide the Name, Address & Telephone Numbers of two references)       PART III - PROJECT SUMMARY MAXIMUM - 1 PAGE (Please reserve detailed explanation for Part IV) Please Attatch Typed Project Summary to Application. Make sure to Title Summary correctly! Please provide a summary of your project including: the goals you hope to achieve, the need for the project, the benefits to the individual or others, how you have planned it and intend to carry it out, a description of the personnel involved, and how you will evaluate its success. PART IV - DETAILED PROJECT DESCRIPTION MAXIMUM: 3 PAGES Please Attatch Typed Project Description to Application. Make sure to Title Project correctly! Please provide a detailed explanation of the project including information under each of the following headings: GOALS/OBJECTIVES: Describe the intended goals or objectives of the project. If there is more than one goal or objective, please state that and list them in order of priority. SIGNIFICANCE/NEED: Describe the need or significance of the project. BENEFITS: Describe who the project will benefit and why. PLANNING APPROACH: Describe research into other projects and/or personnel that has been done by the organization to assist in implementing the project. IMPLEMENTATION: Describe the step-by-step plan for implementing the project with a detailed timetable of activities. PERSONNEL: Describe who will oversee the project, and any contracted personnel that will be hired. Include their qualifications. EVALUATION: Describe how the organization will evaluate the success of the project and whether intended goals and objectives were achieved. FUTURE PLANS: Describe any future plans the organization has if the project is ongoing in nature. PART V - PROJECT BUDGET EXPENDITURES DETAIL Please complete only the sections below that apply to this project. The Basis of Calculation (where indicated) should explain how you have arrived at your estimates--i.e., name of company, # of days, etc. TUITION / REGISTRATION: Name of Person or Group Institution/School Amount Requested ladfkvn;df;hgdflkg;aldfkhg ladfkvn;df;hgdflkg;aldfkhg ladfkvn;df;hgdflkg;aldfkhg ladfkvn;df;hgdflkg;aldfkhg ladfkvn;df;hgdflkg;aldfkhg TRANSPORTATION: Identify each person for whom a transportation allowance is requested and the destination(s) to be visited. Identify the type of transportation, number of visits, and projected cost. NOTE MAXIMUM: Kilometer reimbursement = $ .25/km Name Destination Mode of Transportation Basis of Calculation Amount Requested ladfkvn;df;hgdflkg;aldfkhg         ladfkvn;df;hgdflkg;aldfkhg         ladfkvn;df;hgdflkg;aldfkhg         ladfkvn;df;hgdflkg;aldfkhg         ladfkvn;df;hgdflkg;aldfkhg         SUBSISTENCE: Identify the person for whom subsistence is requested and indicate the length of stay at each destination. NOTE MAXIMUM: $22.00/day for meals $30.00/day for room Name Destination Number of Days Basis of Calculation Amount Requested                                                   TECHNICAL REQUIREMENTS: Including technical consultation, rental of equipment, photocopying. Type of Service Basis of Calculation Amount Requested                               SUPPLIES & MATERIALS: Including stationery supplies. Items Basis of Calculation Amount Requested                               OTHER EXPENDITURES: Items Basis of Calculation Amount Requested                               PART VI - PROJECT BUDGET SUMMARY PROJECT PERIOD _______________        _______________                                    Start Date (D/M/Y)       End Date (D/M/Y) PROJECT EXPENDITURES: (Totals from Part V) Complete only the Estimated column at time of application. Complete only the Actual Column after completion of project. Estimated Actual Tuition Transportation Subsistence Technical Requirements Supplies & Materials Other Expenditures TOTAL EXPENDITURES PROJECT REVENUE:   Estimated Actual Total Other Sources (see below also) * Total Self-Generated DSI Grant Request TOTAL EXPENDITURES OTHER SOURCES OF SUPPORT: Please indicate any other funding agencies from whom you have requested, or plan to make a request for funding for this project, as well as the amount and status of the request (i.e., Confirmed, Pending, Declined). Applicants are asked to notify Dance Saskatchewan Inc. (DSI) when they receive final notification on any grant request. Organization & Project Title Amount Requested Status of Request       TOTAL OTHER SOURCES $ * (place this total in the Projected Revenue line Total Other Sources) _________________________                            __________________________ Signature of Principal (At time of Application)             Signature of Principal (When follow-up is completed) The following information is used for statistical purposes and will be used for ranking the grant applications: What is your recent level of involvement with Dance Saskatchewan Inc.? ___ Yes ___ No Have you attended a DSI hosted master class? ___ Yes ___ No Have you attended Summer Steps? ___ Yes ___ No Have you recommended the DSI master class or Summer Steps to others? ___ Yes ___ No Have you told others about your membership in DSI? ___ Yes ___ No Have you auditioned for Dare to Dance? ___ Yes ___ No Have you been in the audience of Dare to Dance? ___ Yes ___ No Have you written an article for Footnotes? ___ Yes ___ No Have you used the DSI Resource Centre? ___ Yes ___ No Have your purchased materials from the DSI boutique? ___ Yes ___ No Have you responded to calls for dated material that will help us keep the calendar current? ___ Yes ___ No Have you received a grant application from DSI in the last five years. If so, when? __________ I, _____________________________, have read, understand and agree to the above conditions for Dance Saskatchewan Inc. grant applications and recipients of grants. _________________________________ ____________________________ Signature                                                     Date Mail, along with the completed application to: (The following information is used for statistical purposes. Although it is not used in assessing your request, this section must be completed). What is your recent level of involvement with Dance Saskatchewan Inc.? Dance Saskatchewan Inc. Box 8789 Saskatoon, Saskatchewan S7K 6S6 Or Hand Deliver to: Dance Saskatchewan Inc. 205A Pacific Avenue Saskatoon, Saskatchewan Phone: 1-800-667-8480 or 931-8480 (in Saskatoon)