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KPAN FORMS
KPAN
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Application Form
Kentucky Peer Advisory Network
Grant Program

PLEASE NOTE: While filling out the form below, DO NOT press the Enter/Return key as this will submit the form prematurely.

Fields designated with ** are required.

Applicant Name:  **
Salutation: Mr.     Ms.     Mrs.    Dr. 
Director/Administrator Name & Title (if applicable):  **
Street Address:  **
City:  **    Zip+4:  **
County:
Phone Number:  **
FAX:
Email:  **
Website:

US Congressional District #:    
KY Senate District #:        KY Congressional District #:  

To look up district information, use http://www.vote-smart.org
or call yourcounty clerk's office.
 
Applicant Race:  
Applicant Status:  
Applicant Institution:  

Brief History of Organization/Artist: (Please limit answer to 500 characters or less)


 

Description of types of programs, services or products you offer: (Please limit answer to 500 characters or less)


 

Brief description of organization/art: (Please limit answer to 500 characters or less)


 

Brief description of who your programs/art are designed to serve: (Please limit answer to 500 characters or less)


 

Brief explanation of why you are seeking assistance through the KPAN program. (Please limit answer to 500 characters or less)


 

Please identify the topic area that best describes the type of assistance you are requesting:
CLICK HERE to see descriptions of topics.


 

Please complete the following statement:
At the conclusion of the KPAN consultancy we/I hope to be able to...
 (Please limit answer to 500 characters or less)

 

If you are an organization, please tell us the names/titles/phone/email of at least 3 individuals you expect to participate in the consultancy:

Name:  
Title:    
Phone: 
Email:  


Name:  
Title:    
Phone: 
Email:  


Name:  
Title:    
Phone: 
Email:  

 

Thank you for your interest in the work of the
Kentucky Arts Council and support of the arts in Kentucky.

    

NOTE: You must press the Submit Button to send this form.


Kentucky Arts Council
Home

Kentucky Arts Council
500 Mero Street
21st Floor, Capital Plaza Tower
Frankfort, KY 40601
502-564-3757
Toll Free: 888-833-2787
FAX: 502-564-2839

Page Updated: 06/23/2008

KPAN FORMS