Eugene Lang Bursary Form

I am a member of the QAC

We are a school or classroom within Hastings and Prince Edward Counties

Contact name *

First

Last

Group/School Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone

Email *

A brief but detailed description of the project

Or, upload your project description

Click or drag a file to this area to upload.

Ages and grades of students participating

Artist(s) names

Date(s) of workshops

Number of students participating

Number of audience reached

A project budget outline

Or, upload your project budget

Click or drag a file to this area to upload.

Follow-up plan for evaluations/report

Or, upload your follow-up evaluation/report plan

Click or drag a file to this area to upload.

Should this project receive funding from the QAC I agree to the following: *

Invite members of the QAC to attend performance/exhibition/workshop.
Provide a written summary and photos that can be used by the QAC for publication and grant purposes.
Funds from the QAC are for artists fees. Payment will be made to the school ONLY upon receipt of the artist’s invoice, summary and photos.

Please note: All boxes must be checked to be eligible for consideration.