ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 2 of 30

A. PURPOSE 4

B. BACKGROUND INFORMATION 4

C. FUNDING PROCESS 4

D. BUDGET 4

E. SUBMISSION DEADLINE 4

F. GOALS 4

A. WHO CAN APPLY- GENERAL ELIGIBILITY 6

B. EXAMPLES OF WHAT GRANTS CAN BE USED FOR 6

C. WHO CAN NOT APPLY - INELIGIBILITY 6

D. EXAMPLES OF WHAT THE FUNDS MAY NOT BE USED FOR 6

REVIEW CRITERIA AND SCORING

A. THE REVIEW AND SELECTION PROCESS 8

B. GENERAL CRITERIA AND SCORING 8

C. THE RANKING 9

HOW TO APPLY (FOR INDIVIDUAL, ARTISTS, ENTERTAINERS) 11

INDIVIDUAL ARTIST APPLICATION FORM 12

HOW TO APPLY (FOR ORGANIZATIONS) 18

ORGANIZATION APPLICATION FORM 19

DELIVERY OF APPLICATION FOR INDIVIDUALS AND

ORGANIZATIONS 25

BUDGET INFORMATION 27

A. CONTRACTS AND PAYMENTS 27

B. PROJECT CHANGES 27

C. FINANCIAL MANAGEMENT 27

D. FINAL REPORT FORM 27

E. PUBLIC ACKNOWLEDGEMENT 28

PERFORMING AND VISUAL ARTS FUND GRANT

FINAL REPORT FORM 29

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 3 of 30

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 4 of 30

A. PURPOSE: The Illinois Blues Coalition Fund Grant Program was established to

promote and stimulate the growth of the art form of blues related music by performance,

by interpretation, by preservation and by enhancement through a grant application

process for recognized Blues Societies, Blues Music Entertainers and Blues Music

educators. The grant fund supports art projects in blues music in the following fields:

music, recording and live presentations, blues art, theater, photography, visual arts,

dance, design or interdisciplinary expressions involving more than one of the above

fields.

Through this program the Illinois Blues Coalition, Inc. seeks to equitably and

economically support the creative arts designated to blues music.

B. BACKGROUND INFORMATION: In 2004 the Illinois Blues Coalition, Inc. was

formed to promote the art form known as the blues. It was determined that a fund which

was strictly concerned with offering grants was in need to help the various organizations,

entertainers and educators to continue in their efforts to promote blues music as an art

form. This fund, referred to as the Illinois Blues Coalition Fund was designated to be

used for these grants as well as a process to administer these allocations.

This process was completed and the Illinois Blues Coalition, Inc. was designated to be in

charge of the Illinois Blues Coalition Fund Grant process with recommendation by the

Cultural Arts Coordinator and final approval concerning use of these funds being made

by the Board of Directors

CULTURAL ARTS COORDINATOR

Ed Knott

BOARD OF DIRECTORS

Jay Goldberg, President

Peggy Goldberg, Director/Treasurer

Mike Armintrout, Director/Secretary

C. FUNDING PROCESS: Funding awarded annually to qualified applicants. Funding

is awarded through the Illinois Blues Coalition, Inc. via an annual competitive

application/review process. Applicants must make a clear case for funding, based on

established criteria.

D. BUDGET: The total grant budget for the year 2009 will be announced in

February of 2009. Since the grant amount is based on cash on hand, money to be awarded

will change each year. The range of grants is expected to be from $250 to $2,500.

F. SUBMISSION DEADLINE: Through its office, the Illinois Blues Coalition, Inc. will

award grants to organizations and individuals during the year 2009 beginning on May 1,

2009. The GRANT APPLICATION DEADLINE DATE for the year 2009 will be April

1, 2009, BEFORE 5:00 P.M.

F. GOALS:

1. To increase public awareness of the art form known as Blues Music.

2. To encourage the growth of local, statewide and National arts resources

3. To promote cooperation and collaboration between the Illinois Blues Coalition and

performing and visual arts individuals/groups/agencies/organizations/schools

4. To help serve the cultural needs of the blues music community

5. To broaden and leverage public and private support for blues music.

6. To maintain and preserve the Blues Music’s artistic cultural and historic heritage

7. To support exemplary community arts education in blues music.

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 5 of 30

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 6 of 30

A. WHO CAN APPLY- GENERAL ELIGIBILITY

1. Tax-exempt, non-profit recognized Blues Music organizations and Blues Societies.

2. Educational institutions

3. Performance groups associated with schools or educational institutions

4. Visual arts groups associated with educational institutions

5. Blues Music entertainers with documented history of performing blues music.

6. Individuals who want scholarships for study (must show enrollment in educational

institution and specific blues music related class)

7. Entertainers that want travel expenses related to a performance

B. EXAMPLES OF WHAT THE GRANTS CAN BE USED FOR:

1. Funds to pay artist for a performance(s) or exhibition(s)

2. Materials for a creative event (i.e., supplies (e.g., paint, paper) needed to

present a concert or event)

3. Costs of printing programs, pamphlets, etc.

4. Rental of equipment for a production

5. Purchase of equipment to compliment a musician and/or organizations needs.

6. Programs that promote blues music.

7. Recording sessions, cd manufacturing, promotional items.

8. Entertainer’s travel for competitions, important showcase engagements. etc.

9. Cds and sheet music to donate to libraries

10. Blues in the Schools type workshops and general assemblies

Items not covered in this section may be considered (under special circumstances)

by the Illinois Blues Coalition Board Of Directors.

C. WHO CAN NOT APPLY- INELIGIBILITY

For-profit organizations, institutions and businesses shall not be eligible to apply for

grant funds. However, non-profit organizations may partner with for-profit

organizations, institutions and businesses For example, The River City Blues Society

could apply for funds to present a concert by the “legends of The Blues” touring

company.

Individual shall be eligible to apply in an effort to develop blues music talent.

D. EXAMPLES OF WHAT FUNDS MAY NOT BE USED FOR:

1. Purchase of land, equipment, buildings or construction (a capital outlay or

expenditure)

a. these are good examples of capital outlay/expenditures granted funds

b. major purchases musical instruments, DVD, computer

2. Salaries of Management and Staff

a. administrators

b. program and project managers/ment

c. support staff: example secretary, receptionist, etc.

3. Trust/endowment funds- to create or add to existing funds

4. Hospitality or food costs

a. cost associated with planning and giving receptions, dinners

b. purchase of alcoholic beverages

c. cost of decorations associated with items mentioned above

5. Dues

a. to join various art, civic, or religious group

6. Indirect costs of schools (school costs not related to this grant)

7. No funds will be expended for persons or groups using “fighting words” or “Hate

words” (any offensive words or messages which are inherently likely to provoke any

immediate violent reaction or preach hatred of people or ethnic groups, etc.)

8. Programs not accessible to the public

a. programs or events held in private homes or private spaces

9. Cost of entertainment, Sound and/or lighting system associated with an event

which is dependent on ticket sales to generate revenue.

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 7 of 30

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 8 of 30

A. THE REVIEW AND SELECTION PROCESS

Each grant application will be reviewed by the Cultural Arts Director. The charge is to

review all eligible grant applications, determine project worthiness and recommend

appropriate funding levels. Applications are evaluated with short narrative comments,

given numerical scores (0-100) and collectively ranked. The rankings will range from 4-1

with 4 being the highest score an application can receive. After the review process, the

Cultural Arts Director will forward his/her recommendations to the Board Of Directors

for final approval. All applicants will receive written notification of results in May.

B. GENERAL CRITERIA AND SCORING

Individual entertainers and organizations are judged on the following criteria and point

system with a possible 100 total points.

1. Project Administration Capability

Maximum of 10 points

Scores for capability or “feasibility” include the clarity and thoughtfulness of answers to

The application questions, the business skills and production accomplishments on

submitted information, the relation to Blues Music, the appropriateness of the project

budget (the estimated value of each expense and the total project cost in relation to the

number of people served); the appropriateness and stability of a project’s venue, and a

realistic, detailed time line.

2. Artistic Merit

There’s a maximum of 30 points for organizations and 50 points for individual

entertainers

Scores for artistic merit reflect the accomplishments listed on submitted materials,

attached reviews/press materials, the strength and relevance of letters of support. The

merit of a project is judged against the merit of projects proposed by other applicants in

the same discipline in the area of Blues Music.

3. Creativity and Innovation

Maximum of 20 points

The creation of new works with new ideas or new methods, a new interpretation targeting

a new audience or the creation of new works with traditional methods will be judged

against the other applications. In other words, how this project promotes the growth and

future of Blues Music.

4. Community Impact

Maximum of 20 points

Community impact is an assessment of the project's ability to inform or promote Blues

Music in either the general community or its target audience. How many people will be

served and how well will your proposed activity stimulate cultural exchange or broaden

the understanding of Blues Music? How does your project represent or serve the Blues

Music constituencies in the area while meeting your project goals and the needs of the

community?

5. Societal Relevance To Blues Music

Maximum of 20 points for organizations (not applicable for individual artists)

Will your project feed, build, or cure the spirit of Blues Music? Relevance implies need

and includes an assessment of how your audience’s involvement will determine project

success. How does the proposed project address societal issues of Blues Music, intersect

with community, address universal or contemporary issues or leave a legacy for the

community.

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 9 of 30

C. THE RANKINGS

The ranking of each grant will be determined by the following point system:

100 - 89 points = 4 ranking

88 - 79 points = 3 ranking

78 - 65 points = 2 ranking

64 and below = 1 ranking

4 Designates an applicant as the highest priority for funding. These are

considered to be “model” in stature and to meet all review criteria to

the highest degree.

3 Considered good to excellent and receives funding, but less than that of a

4 designate applicant. This is a very good ranking and indicates a very

solid organization/project that is approaching “model” status. However,

there is room for improvement or development.

2 Considered to be marginally fundable, and only if there are available

funds. Applicant shows some merit but does not meet the criteria in a

strong or solid way.

1 Not fundable under any circumstances, inappropriate for funding.

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 10 of 30

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 11 of 30

Step 1: Complete and sign the Illinois Blues Coalition Fund Grant Application Form

pertaining to INDIVIDUAL, ARTISTS AND ENTERTAINERS

Step 2: Complete the “Proposal Narrative” sheet

Step 3P:repare your support materials and complete the “Sample Artistic

Documentation” form if you are submitting support materials

Step 4: The application packet and support materials must be received no later than

5:00 p.m. on April 1, 2009 at the following address:

Illinois Blues Coalition, Inc.

2130 Sunset Drive

Pekin, Illinois 61554

CULTURAL ARTS COORDINATOR / ED KNOTT

Organization/Individual Name

Address

Phone/Contact Person

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 12 of 30

Page 1 of 5

Name:________________________________________________

Grants up to $2,500 are offered to individuals, artists and entertainers for the creation of

specific performing or related projects that will enhance and promote the art form of

blues- related music. The individual, artist or entertainer should focus on creative or

aesthetic ideas and be informative as to how this grant would enhance your career and/or

ability to promote the Blues Music art form.

Requirements:

1. Project(s) must be specific to Blues Music and promote the art form.

2. Funding must enhance your ability to advance your career and/or be educational

in content

Criteria for Evaluations:

1. Project Merit

2. Individual’s, Artist’s or Entertainer’s History and Project Vision

3. Public Benefit and Potential

4. Social Relevance to Blues Music.

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 13 of 30

Page 2 of 5

Name:________________________________________________

1. Name of Individual, Artist or Entertainer_____________________________________

2. Address:______________________________________________________________

3. City_______________________________ State______ Zip Code________________

4. Phone #________________Fax_________________

5. E-Mail________________

Grant Project Title_________________________________________________________

Grant Amount Requested: $__________________

Certification: I certify that the information contained in this application, including all of

the attachments and supporting materials, is true and correct to the best of my knowledge.

If payment is to be made to anyone other than the grantee, it is understood that the

grantee is financially, administratively, and programmatically responsible for all aspects

of the grant and that all reports must be submitted through the grantee.

Individual, Artist, Entertainer:

________________________________________________________________________

Signature Date

________________________________________________________________________

_

Printed Name

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 14 of 30

Page 3 of 5

Name:________________________________________________

Briefly and concisely answer the following questions in the space provided.

1. Briefly describe your past contributions to your discipline, profession, etc. as relates to

Blues Music. Use additional pages if necessary

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 15 of 30

Page 4 of 5

Name:________________________________________________

2. Give your Project Description and Evaluation (use additional sheets if necessary)

A. Describe the proposed project.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

B. What do you envision the project's impact to be on the Blues Music

community?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

C. How do you plan to evaluate the success of this project?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 16 of 30

Page 5 of 5

Name:________________________________________________

3. Please give a project budget summary below:

A. Total project expense: $_______________

B. Amount requested from this grant: $_______________

C. Total In-Kind donation received: $_______________

D. Itemized expenses in detail related to grant project expenses:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

It is recommended that applicants submit materials which represent and uphold their

grant proposal and from which the Board Of Directors may evaluate artistic merit.

Select and label your submission (video, audio, slides) with

A) Applicant name

B) the title of the work(s)

C) the date of the work

Write a brief description of each submitted material and include with this application.

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 17 of 30

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 18 of 30

Step 1:Complete and sign the Illinois Blues Coalition Fund Grant Application Form

pertaining to INDIVIDUALS, ARTISTS AND ENTERTAINERS

Step 2: Complete the “Proposal Narrative” sheet

Step 3P:repare your support materials and complete the “Sample Artistic

Documentation” form if you are submitting support materials

Step 4:The application packet and support materials must be received no later than 5:00

p.m. on April 1, 2009 at the following address:

Illinois Blues Coalition, Inc.

2130 Sunset Drive

Pekin, Illinois 61554

CULTURAL ARTS COORDINATOR / ED KNOTT

Organization/Individual Name

Address

Phone/Contact Person

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 19 of 30

Page 1 of 5

Name of Organization: ___________________________________

1. Name of Organization___________________________________________________

IRS Nonprofit Organization Identification # (501)( c)(3):____________________

2. Address:______________________________________________________________

3. City_________________________State ________ Zip Code____________________

4. Phone #________________Fax_________________ E-Mail____________________

5. Contact Person on Board of Directors:______________________________________

6. Administrative Director__________________________________________________

7. Contact Person For Grant____________________________Title_________________

Applicant’s Organizational Discipline_________________________________________

Grant Amount Requested:$_________________

Date the applicant received its 501(c)(3) and/or State nonprofit status______________

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 20 of 30

Page 2 of 5

Name of Organization: ___________________________________

Certification: I/We certify that the information contained in this application, including

all attachments and supporting materials, is true and correct to the best of our

knowledge. If payment is to be made to anyone other than the grantee, it is understood

that the grantee is financially, administratively, and programmatically responsible for all

aspects of the grant and that all reports must be submitted through the grantee.

Organization Director: Board President:

________________________________ ________________________________

Signature Date Signature Date

________________________________ ________________________________

Printed Name and Title Printed Name and Title

________________________________ ________________________________

Printed Title Printed Title

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 21 of 30

Page 3 of 5

Name of Organization: ___________________________________

PROPOSAL NARRATIVE

Briefly and concisely answer the following questions in the space provided.

1. What is your organization's mission?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

2. List some major accomplishments of your organization in the space provided.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 22 of 30

Page 4 of 5

Name of Organization: ___________________________________

3. Give your Project Description and Evaluation in the space provided.

A. Describe the proposed project.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

B. What do you envision this project's impact to be on the Blues Music

community?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

C. How do you plan to evaluate the success of this project?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 23 of 30

Page 5 of 5

Name of Organization: ___________________________________

4. Please give a project budget summary below:

A. Total project expense: $_________________________________________

B. Amount requested from this grant: $______________________________

C. Total in-kind donations received: $________________________________

D. Itemized expenses in detail related to grant project expenses.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

It is recommended that applicants submit materials which represent and uphold their

grant proposal and from which the Board Of Directors may evaluate artistic merit and

relevance to Blues Music.

Select and label your submission (video, audio, slides) with

A) Applicant name

B) the title of the work(s)

C) the date of the work

Write a brief description of each submitted material and include with this application.

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 24 of 30

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 25 of 30

Application packet and support materials must be received no later than 5:00 p.m. on

April 1, 2008 at the following address:

Illinois Blues Coalition, Inc.

2130 Sunset Drive

Pekin, Illinois 61554

FOUR COPIES OF THE PAPER APPLICATIONS AND ONE SET OF THE SUPPORT

MATERIALS (IF APPLICABLE) MUST BE SUBMITTED.

IMPORTANT RECOMMENDATION

It is recommended that you contact Jay Goldberg at 309-208-4300 prior to the due date if

you have any questions regarding filling out the grant application.

Arrangements can be made to pick up any support materials which you may have

submitted from the Office of the Illinois Blues Coalition, Inc, after the grant letter has

been received, by calling Jay Goldberg at 309-208-4300.

If you wish to have materials returned, submit a stamped, self-addressed envelope.

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 26 of 30

BUDGET INFORMATION

A. CONTRACTS AND PAYMENTS

B. PROJECT CHANGES

C. FINANCIAL MANAGEMENT

D. FINAL REPORT FORM

E. PUBLIC ACKNOWLEDGMENT

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 27 of 30

In completing the proposed budget plan, be very specific in your presentation about how

Illinois Blues Coalition Fund Grant money would be spent during the grant period

(contract date)

A. Contracts and Payments: The Illinois Blues Coalition reserves the right to

negotiate the amount and location of grant-funded activities.

Contractual funds will be mailed to grant recipients in full within 30 days of

Illinois Blues Coalition, Inc. Board of Directors approval. A final report form

(included in this packet) is required from all grant recipients. All project

receipts must be attached and the project must have been reviewed and accepted

by the Illinois Blues Coalition, Inc. The grantee will be required to reimburse to

the Illinois Blues Coalition, Inc. any monies for which receipts are not available at

the end of the project.

B. Project Changes: Proposed changes to approved projects and the contractual

agreement for grant funds must be submitted in writing to the Cultural Arts

Coordinator by the grantee for approval.

Any changes in purpose, personnel, location, date, activity or budget must be sent

to the Cultural Arts Coordinator for approval before the grant funds may be used

for that purpose.

C. Financial Management: Grant recipients are required to maintain accounts,

records and other evidence pertaining to cost incurred and revenues acquired

under the respective grant program.

More specifically, grantees are required to provide, as requested by the Illinois

Blues Coalition, the following information upon completion of their project:

1. Accurate, current and complete disclosure of the financial

accounting for the grant project

2. Records that identify adequately the services and resources paid

for by grant funds (supported by invoices, receipts, bank

statements, etc.)

D. Final Report Form: The project must be completed one year from the grant

notification date. The Final Report Form must be returned no later than 10 days

after the completion of the project. You will not be eligible to apply for another

Illinois Blues Coalition Fund Grant until all documentation for your current

project has been received and approved by the Illinois Blues Coalition, Inc. Board

of Directors. Failure to comply with these requirements will make you ineligible

for an Illinois Blues Coalition Fund Grant for ensuing years.

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 28 of 30

E. Public Acknowledgment: Each grant recipient shall credit the Illinois

Blues Coalition Fund for its contractual support of the project in all printed and

broadcasted promotions, brochures, posters, programs, handbills and other promotional

materials. All printed materials should carry the following phrase:

“This (program, activity, etc.) is made possible in part by a grant from the Illinois Blues

Coalition Fund”

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG , PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 29 of 30

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

illinois_blues_coalition@jaytv.com

http://www.jaytv.com/illinoisbluescoalition

FINAL REPORT FORM

Illinois Blues Coalition Fund Grant

DATE SUBMITTED _________________(MUST BE DATED)

________________________________________________________________________

Organization Name Contact Person

________________________________________________________________________

Address

________________________________________________________________________

City State Zip Code Telephone No.

________________________________________________________________________

E-mail address

1. State your objectives briefly and whether they've been met.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

2. State briefly the impact of the project on the public.

________________________________________________________________________

________________________________________________________________________

ILLINOIS BLUES COALITION, INC

GRANT APPLICATION PACKET

Page 30 of 30

3. Do you have any suggestions on how the program can be improved?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

4. Please circle one of the following:

The overall grant program was:

•• Excellent •• Very Good •• Good •• Fair •• Poor

5. Please attach final budget of project showing revenue and expenses.

Signature:

________________________________________________________________________

Name (print or type)

________________________________________________________________________

Title ___________________________________________________________________

Upon completion of project, please submit final report form and any publicity materials

to:

ILLINOIS BLUES COALITION, INC.

JAY GOLDBERG, PRESIDENT

2130 SUNSET DRIVE

PEKIN, ILLINOIS 61554

FINAL REPORT

Page 2 of 2