^{GET SET! Grant Application}

(Please print this form)

Organization Name _________________________________________________

Address____________________________________________________________

Contact Person for this proposal _______________________________________

Daytime Phone Number _____________________ Fax __________________

E-mail _____________________________ Today's Date____________________


1. Is the organization chartered by NY State’s Board of Regents? Yes __ No __

2. Is the organization a:

___501C3 ___Branch of local government ___Other______________________

3. Annual Operating Budget: ___________________

4. Have you applied to the NYSCA Museum Program in the past? Yes ____ No ____

If so, date of last contract______________________________________________________


5. Provide a two-page project narrative addressing the following:

1. The primary issues to be addressed in the consultancy and how the consultancy will advance a goal within your strategic plan or assist you in completing a strategic plan
2. Why is this consultant appropriate for the project?
3. A work schedule:
   • How often will the consultant visit?
   • What will be accomplished during consultancies?
   • What work needs to be done by staff and board?
4. What impact will this consultancy have upon your organization?

6. Please attach the following:

1. Strategic plan (unless applying for planning) and mission statement (required)
2. Resume of proposed consultant (required)
3. Newsletters, brochures, annual reports or other information about your organization (optional)

7. Budget:

1. Consultant's Fee $________________
2. Travel (in state only) $______________ Mileage: ______ miles@_______
   • Other (specify) $________________

Total $________________*

*If the total exceeds the GET SET! limit of $3000, how will your organization support the remaining expenses?

Mail four (4) copies of this application and all supporting materials to UHA at 11 Ford Ave, Oneonta NY 13820