Business Volunteers for the Arts



|GENERAL INFORMATION |

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|Name of Arts Organization |

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|Name & Title of Person Completing Form Executive Director’s Name (If different) |

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|Street | |City | | State Zip |

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|Email | | Phone | Cell Phone |

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|Website/Online Page |

|Check the box below that best describes the current status of your organization: |

| Nonprofit, 501(c)(3) -Year established: |      |

| New organization in process of filing for 501c3 status |

| Organization operating under fiscal sponsorship of another nonprofit |

| Please provide name of fiscal sponsor or umbrella organization: |      |

| Organized as a for-profit (may not be eligible for assistance) |

| Other - please explain: |      |

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|Check the box below that reflects the current operating budget of your organization: |

| Under $25,000 | $25,0000 to $100,000 | $100,000 to $250,000 | Over $250,000 |

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|In what artistic discipline is your organization involved? (Check all that apply) |

| Ceramics | Drawing/Painting | Media Arts | Sculpture |

| Craft | Fiction | Multidisciplinary | Storytelling |

| Dance | Folk Arts | Music | Theatre |

| Design Arts | Literature | Photography | Other:       |

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|Briefly describe the nature of your organization’s purpose and activities: |

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|DESCRIPTION OF BUSINESS ASSISTANCE REQUESTED |

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|Briefly describe the project for which you would like BVA assistance. |

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|ADDITIONAL DOCUMENTATION |

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| |I have enclosed the following documentation: |

| |Board of directors, listed with professional affiliations |

| |Audited 990 or financial statements for most recently completed fiscal year if audit not available |

| |Other material relevant to my organization and request for assistance |

| |Please provide a description       |

|FEES AND AUTHORIZATIONS |

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| |I have enclosed the Application Fee ($35 for GPAC Members and $50 for non-Members) | |

| |Application fee can be paid via check or by credit card at | |

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| |I hereby affirm that the information contained in this application is correct and, to the best of my knowledge, complete. This |

| |questionnaire fully and accurately describes the problem(s) for which the within named individual requests assistance. I understand |

| |that (1) Greater Pittsburgh Arts Council (GPAC)/BVA cannot guarantee that a volunteer will agree to take on our request; (2) GPAC/BVA |

| |will not be responsible for the outcome of any request handled by a BVA Volunteer; (3) I am free to select/not select any volunteer who|

| |may offer to assist me; (4) the scope of any assistance by a BVA Volunteer is limited to the above described problem as may be further |

| |defined in any subsequent agreement between the BVA Volunteer and me; (5) GPAC/BVA does not make any representation or guarantees about|

| |the quality of business assistance I will receive; (6) I will be advised by the BVA Volunteer, and not GPAC/BVA; and (7) I agree to |

| |promptly notify GPAC/BVA if I no longer requires the services of a BVA Volunteer.. |

|Greater Pittsburgh Arts Council funding sources frequently ask for documentation regarding who we have served. If it is determined that |

|your organization is eligible for assistance, may we list your organization? (Your answer does not affect your eligibility in any way.) |

|yes no |

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|Applicant Signature |Date |

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|Submit by Email: Please save this document for your records, and email it as an attachment to Larry Castner at |

|lcastner@ |

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|Submit by Mail or Fax: Mail to the Greater Pittsburgh Arts Council - BVA, 810 Penn Avenue, Sixth Floor, Pittsburgh, PA 15222-3401, or fax to |

|412.394.4280. |

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|Questions? Contact Larry Castner at lcastner@ or 412.391.2060 x229. |

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