Art is a catalyst
for personal empowerment, creativity, community building and positive
social change.
SYNERGY ART FOUNDATION
251 Barbara Ave.
Solana Beach, California 92075 | Tel and Fax: (858) 509 1155
| Email: nnartd@gmail.com
SD- Emergency Artist Support League The SD-EASL Fund provides
limited financial assistance to San Diego County arts professionals who
are in dire temporary distress because of an unforeseen medical emergency
or other catastrophic event. Address
________________________________City ______________
County_______________________ State _____ Zip __________________ Phone _______________________ Cell ________________________ Social Security Number ________________________ The maximum grant available is $1,000 per emergency, or
$2,500 for major medical emergencies, annually. The SD-EASL Fund is open
to artists, both visual and performing, who have lived in San Diego County
for a minimum of two years and are pursuing an art career as evidenced by
a record of exhibitions and/or significant involvement in the San Diego
arts community. All questions must
be answered completely and all requested materials enclosed in order for
your application to be evaluated. What is the nature of your
emergency? Date of emergency ______________________ Estimate of total amount needed to recover, pay bills,
etc. $ _________ How much money are you requesting from the SD-EASL
Fund? $ _________ Service provided
_____________________________________________________________________
Administered
by Synergy Art FoundationGrant
Application
Name _____________________________________________ Email ______________________________
Limit your description to the space below. Attach documentation where
possible or appropriate (i.e. doctor/hospital bills, police report,
eviction notices, utilities notice, newspaper article, etc.).
Synergy Art Foundation prefers that checks be written to service
providers. List in priority those who would receive payment from your
grant.
Check written to ___________________________________________ Amount $_________________
SD-EASL
Grant Application/Page Two
Employed? ___
Full-time ___ Part-time ___
How long? _______________
If yes, list current employer, name, address, phone number. If no, list last
employer and ending date of last employment.
If self-employed, please state for how long and annual average
income over the past 3 years?
List
all sources of income.
What
other grants or funding (i.e. insurance, fundraising efforts, etc.) have you
received related to this emergency?
We
may require proof of your financial status and/or residency (driver's
license, voters registration card, etc.) Is such documentation available? If
not, please explain.
List three references who would know about your current situation.
Include their addresses, telephone numbers and your relationship to them.
1.
2.
3.
List at least one professional reference who can verify your status as
an arts professional.
Is there someone we may contact on you behalf if we are unable to reach
you? List name, address, phone number and relationship.
How did you learn about SD-EASL?
As
documentation of your professional status and exhibition/performing arts
history, please enclose/attach your resume.
Signature of applicant
_______________________________________________ Date
_____________________________
Send this completed form to:
Synergy Art Foundation SD-EASL
251 Barbara Avenue, Solana Beach, CA
92075
or email to nnartd@gmail.com
All information received
regarding this application will remain strictly confidential.