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- Performers & Writers Emergency Relief The SD-PWER Fund provides limited
financial assistance to San Diego County professional performing
artists and/or writers 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-PWER
Fund is open performing artists and writers, who have lived
in San Diego County for a minimum of two years and are pursuing
acareer as evidenced by a record of performances/publications
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-PWER 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-PWER
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-PWER?
As
documentation of your professional status and performing/published history,
please enclose/attach your resume.
Signature of applicant
_______________________________________________ Date
_____________________________
Send this completed form to:
Synergy Art Foundation SD-PWERL
251 Barbara Avenue, Solana Beach, CA
92075
or email to nnartd@gmail.com
All information received
regarding this application will remain strictly confidential.