AMERIKA SAMOA HUMANITIES COUNCIL

GRANT APPLICATION

“O LE TAGATA O ANANAFI MA LE ASŌ, E FAATAMAOAIGĀ LE TAGATA O Ā TAEAO” “THE INDIVIDUAL OF YESTERDAY AND TODAY WILL ENRICH THE INDIVIDUAL OF TOMORROW”

Before you submit the proposal for a minigrant check to make sure that you’ve completed the following:

1. 2. 3. 4. 5.

Section I: Application Coversheet Section II: Application Narrative Section III: Project Budget, (Budget Form) and Budget Narrative. Have you include any appropriate attachments, Resume of Humanities Scholar. 9 copies of the Application.

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SECTION II: NARRATIVE Your response to the items listed below will be the body of your application. Use separate paper to explain your project using the points listed below as a guide to compile the proposal. Type written applications are preferred, however, legible print is highly recommended if type written is impossible. 1.

Briefly (3-5 sentences) tell us your organization’s mission, (membership and the executive officers.)

2.

What goal (s) do you expect to achieve at the end of the project?

3.

What objectives do you intend to implement to reach this goal?

4.

Why is this project theme important to the audience?

5.

How will the project improve the intellectual and/or cultural lives of the audience?

6.

What project format and activities will you utilize to present the main theme of the project? (Speaker’s Forum; Workshops; Media, etc.,) Demonstration may accompany any of the formats above. You are not limited to these formats; these are just ideas for starters.

7.

Who are the principal humanities scholar and resource people?

8.

Present a calendar of activities which you intend to implement. (These activities should have a central theme that supports your overall theme and title. List the important dates, time and place of the activities. The presenter for each activity should be listed next to the correspondence date.)

9.

Who is your audience? You must use all possible means to advertise and invite other organizations and individuals to participate in the project.

10.

How will you evaluate the project? Tell us how you will measure the effectiveness of the project. Include samples of evaluation forms, questions, etc.

11.

Complete the Budget Form provided with this application. A budget narrative explaining each line item must accompany the Budget Form.

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AMERIKA SAMOA HUMANITIES COUNCIL “O le Tagata o Ananafi Ma le Aso, e Faatamaoaiga Le Tagata o a Taeao” “The Individual of Yesterday and Today will enrich the Individual of Tomorrow”

APPLICATION COVERSHEET

SECTION I Non-Profit:  Yes  No I. PROJECT SPONSOR:

_________________________________

__________________________________

NAME OF ORGANIZATION

MAILING ADDRESS: P. O. BOX, VILLAGE

_________________________________

_________________________________

TELEPHONE

COUNTRY, ZIP CODE

Submit Resume

2. Project Director:

3. Authorized Representative:

_________________________________________

__________________________________

FIRST, MI, LAST

Name: First, MI, Last

MAILING ADDRESS:

____________________________________

CERTIFICATION:

PO BOX, VILLAGE

By signing and submitting this application the Authorizing official of the applicant. Institution is providing certifications regarding debarment and suspension and compliance with the nonDiscrimination statutes.

_________________________ __________________ COUNTRY, ZIP CODE

_______________________________________________ ___________________________________________

TELEPHONE

SIGNATURE

__________________________________________________ SIGNATURE

Submit Resume

4. Principal Humanities Scholar:_______________________________________________________ Mailing Address:___________________________________ Humanities Discipline:_______________________________ ___________________________________ Telephone:

___________________________________

Signature:________________________________________

5. PROJECT TITLE: Beginning Date____________________Ending Date: ____________________________ PROJECT SUMMARY (Use only Space Provided)

BUDGET TOTALS: $________________ Sponsor Share: $_______________ Third Party:$ _____________ ASHC Grant: _______________ Total: $________________

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AMERIKA SAMOA HUMANITIES COUNCIL PROJECT BUDGET MINIGRANT

SECTION III A. BUDGET CATEGORIES

B. ASHC GRANT FUNDS

C. SPONSOR SHARE CASH INKIND

Personnel: Specify hours

and rate a. Project Director

b. Humanities Scholar c. Resource Persons SUBTOTAL Project Advertisement a. Newspaper

b. Radio c. Other SUBTOTAL Operations Expenses a. Supplies/Materials b. Equipment Rental c. Meetings d. Other SUBTOTAL

Subtotal Column B Subtotal Column C Subtotal Column D Subtotal Cost of Project

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D. THIRD PARTY CASH GIFTS

E. TOTAL

STATEMENT OF THE PRINCIPAL HUMANITIES SCHOLAR Project Title: Project Sponsor: Name of Humanities Scholar: Signature of Scholar Named Above: 1.

The Primary role of the Principal Humanities Scholar is to ensure that the audience receive substantive understanding of the Humanities and a deeper appreciation of their value. Please indicate how the various disciplines of the humanities mentioned in the proposal, including your own discipline, are central to the content of the program or the project. -what major points will you present to the public to discover the topic? -In what ways do you plan to engage the audience in critical thinking on the topic?

2.

In what ways does this project meet the intellectual need of the community with respect to the humanities?

3.

In what ways did you participate in the planning and the development of the project?

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AMERIKA SAMOA HUMANITIES COUNCIL Application: Humanities Scholar I. Name:_____________________________________________________________________ Last First Middle Initial Address:___________________________________________________________________ P.O.Box No.

Village

City/State

Zip Code

Present Employment:______________________________ Title:_____________________ Address:___________________Contact Phone:________________Fax No. (if any)______________________

Place of Birth:_________________________Date of Birth:_________________________ Matai Title (If any):__________________________________________________________ II. What discipline (s) of the Humanities do you consider yourself a scholar of? (Use the space provided to explain in details.)

Attach a 1-3 page resume ___________________________________________________________________________ III. Certification: By signing and submitting this application, I hereby certify that the information provided herewith is true to my knowledge; and that I will work cooperatively with ASHC as a member of the ASHC Speakers Bureau. I agree to take upon all duties herein delegated to me as a Speaker for Amerika Samoa Humanities Council.

I hereby affix my signature on this ____________day of _________________20______

________________________________________ Signature

_______________________________ Date

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