Saranac Lake Young Arts Association

Application for Support for an EDUCATIONAL PROGRAM
Educational programs are taught by compensated instructors approved by SLYAA and are of a set duration in a specified location.
Sponsor __________________________________________________________________________
Address __________________________________________________________________________
City_____________________________________________________State_____ZIP_____________
Phone ____________________________ Email ___________________________________________
Contact Person _____________________________________________________________________
Phone ____________________________ Email ___________________________________________
Title of Program ____________________________________________________________________
Venue ____________________________________________________________________________
Has this space been approved? ________ on ______________________________________________
Date (s) ___________________________________________________________________________
Time (s) ___________________________________________________________________________
How does this program support SLYAA's mission to support and nurture the arts among Saranac Lake school district youth? _______________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Day by day schedule (date, time, place, instructor, course, concert, etc. Please submit additional sheet.
Amount requested from SLYAA $ ______________________________________________________
Signature__________________________________________________________________________
Print name ______________________________________________ Date ______________________

BUDGET/EXPENSES

 clear

INCOME
PERSONNEL (submit resumes please-add categories as necessary) Tuition (per person x # of students) $_______________
Artistic director $_______________ Ticket sales $_______________
Program administrator $_______________ Donations $_______________
Instructor $_______________ In kind (define) $_______________
Instructor $_______________ Other (define) $_______________
Custodial $_______________ clear $_______________
Secretarial $_______________ clear $_______________
Intern(s) $_______________ TOTAL INCOME $_______________
Other $_______________ clear clear
RENTALS (add categories as necessary) clear clear
Space $_______________ clear clear
Instrument $_______________ clear clear
Equipment $_______________ clear clear
PUBLICITY/PRINTING (add categories as necessary) clear clear
Ads(print, electronic) $_______________ clear clear
Printing (programs, brochures, posters,etc.) $_______________ clear clear
Postage $_______________ clear
Other (specify) $_______________ clear clear
OTHER (add categories as necessary) clear clear
Entertainment/refreshments $_______________ clear clear
Housing $_______________ clear clear
Office expense (phone, copying, etc) $_______________ clear clear
SCHOLARSHIPS/AWARDS (see additional SLYAA form) clear clear
Scholarships(submit sheet with names and amounts) $_______________ clear clear
Awards $_______________ clear clear
Other(define) $_______________ clear clear
TOTAL EXPENSES $_______________ clear clear

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P.O. Box 1130 ~ Saranac Lake, NY 12983
Email: info@youngartsonline.org

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