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Jacksonville Dance TheatreAPPLICATION FORM WITH SCORING AND REVIEW CRITERIA AND GUIDANCE Funding amount requested: $ '0°° Dates of event/program start -end 10/19 1 5/20 Yes/No Conditions A. Fair and justifiable program costs (Program/Event Budget required) Yes/No. B. Serves Atlantic Beach residents Yes/No C. Program/event pertains to cultural, arts, recreation Yes/No D. Program/event activities completed by September 30, 2020 Yes/No E. Program/event is non-discriminatory Yes/No F. Is the event free from inherently religious activities? Yes/No NOTE: If the Yes/No conditions are not met, the application is not eligible for funding, and will not be processed for review. NOTE: Questions reviewers will consider are listed in italics as a helpful guide for applicants 1. Participants (Maximum 35 points) ❑ Location(s) where program/event will take place Schools within the Atlantic Beach area O Total estimated number of participants 2,000 ❑ Number and percent of participants who are Atlantic Beach residents # 2,000 % 100 ❑ Total number of hours each participant will be directly engaged in program/event 1 hour ❑ Frequency and duration of program/event (e.g. 1 time event for 2 hours, or 1 x/month for 1 hour) 2 days/school O Is the event open to all residents of Atlantic Beach who may want to participate? No O Is the event to occur in Atlantic Beach or to serve primarily Atlantic Beach? Yes NOTE: An important criteria for funding is to ensure that an adequate number of Atlantic Beach residents will benefit from the program/event relative to the amount of funding requested. To address this criteria, a per -person -per -hour cost will be calculated by the reviewers. 2. Need (Maximum 20 points) Briefly describe any community needs or gaps that the program/event is intended to address. Please state if the program/event targets a population or age group that is currently underserved in Atlantic Beach. NOTE: Reviewers will consider the following questions when assigning points: ❑ Is there a demonstrated need for the program/event? ❑ Is the program/event duplicative of other programs/events in the area? O Is the program/event a response to a need articulated from the community? ❑ Does the program/event target a population group that is currently underserved? (e.g. teens, children with special needs, low-income residents, etc.) Creative T)ance In Schools (CMTS) pairs dance professionals and school systems to provide opportunities for all students to experience the universal lane uawe of dance. No other dance outreach program exists in the Atlantic Beach area that works to collaborate with teachers to reinforce classroom learning during the school day. CDIS is tailored to school -aged children of all abilities, genders, race, background, and creed. CDIS serves students in the classroom during the school day as we recognize that many child ren may not have the means to participate in an after school recreation program. With a Cultural Arts and Recreation Program grant, Jll"1will be able to otter Cll1S at no cost to students, teachers, and schools. 3. Description of program/event 3.1 Describe the goals and objectives of the program/event, and benefits to the residents of Atlantic Beach, please make sure goals and objectives are specific, measurable, achievable, results -focused and time -bound (Maximum 15 POINTS) NOTE: Reviewers will consider the following questions when assigning points: o Are the goals and objectives described in the application SMART (specific, measurable, achievable, results -focused, and time- bound) o How will the program/event benefit residents of Atlantic Beach (pertaining to cultural arts and recreation? o Are the goals and objectives artistic, recreational and/or cultural in nature working on dance principles, art appreciation. gross locomotor skills, self-esteem. empathy. problem solving. appreciation of health and wellness. respective touch. and spatial awareness. These goals and objectives augment student's learning by giving supplemental tools for auditory, visual, somatic, and reflective learners. 3.2 Describe program/event activities (Maximum 40 POINTS) NOTE: Reviewers will consider the following questions when assigning points: o How appropriate are these activities are in terms of achieving the stated goals and objectives o Originality and creativity— is the program or event new and unique to the community or provide a new or unique twist on an existing program or event? o Is this a family oriented and wholesome event that City funding should support? Creative Dance In Schools lessons are structured from a concept -based perspective. We base our lesson plans on BEST dance practices: body, motion, energy, space, time; as well as Bartenieff principles. A typical CDIS lesson follows these stages: 1. Experience/Identify: The concept of the lesson is introduced and explained while warming up, generally through Anne Green Gilbert's Brain Dance. 2. Investigate/Explore: This includes 2-3 different activities that oscillate between guided exploration and development of dance skills. 3. Create/Perform: Older dancers are given a choreographic problem to solve and time is given to show their creations. Younger students are led through a guided improvisation in groups to give dancers a chance to perform and also watch/consume dance. 4. Connect/Analyze: As dancers are led through a cool -down, they are also led in a verbal review of what they learned and real life applications. 3.3 Describe how the program/event will be advertised too ensure adequate participation (Maximum 5 POINTS) NOTE: Reviewers will consider the following questions when assigning points: o is there a plan for promoting/marketing the program/event? o Is this plan likely to be effective and feasible? With the support of a Cultural Arts and Recreation Program grant JDT will be able to offer CDIS at no cost to schools or their families. JDT project managers will work directly with teachers and administrators to coordinate scheduling. JDT has contacts within the Duval Puhlic County School system as well as with residents and teachers in Atlantic Beach. "lhese contacts and relationships will assist m timely delivery of the program. 4 Describe how you will facilitate access to the program or event so that residents of Atlantic Beach who do not live near the program/event location and/or who do not have transportation can still participate. (Maximum 10 POINTS) NOTE: Reviewers will consider the following questions when assigning points: o Is there a plan to ensure that access is not a barrier? o Is this plan effective and feasible? Creative Dance In Schools is an `in -reach' program that takes place during the school daN to provide all students access to the benefits of creative dance -based education. 5 Describe if the program is evidence based (i.e. has a record of achieving expected outcomes) (Maximum 15 POINTS) NOTE: Reviewers will consider the following questions when assigning points: o Is the program or event based on published evidence? o Does the program or event have a demonstrated history of success (in other contexts or similar cities, or in previous years)? Taken from the National Dance Education Drgani7ation• "A correlation has been observed between students who dance and hig ier standardized test scores (College Board statistics ). Throu:Th dance educatior;. students develop focus, concentration, discipline, creativity, problem -solving skills, self-assessment skills, and the desire to do well. In addition, students learn to remember patterns, sequences, relationships, forms, and structures. These transfer into other areas of learning and achievement." 6 If there is a fee or cost to participate, describe how you will ensure that participants are not denied the opportunity to participate due to their inability to pay any registration or other related fees or costs. If there is no fee or cost please state N/A (Maximum 15 POINTS) NOTE: Reviewers will consider the following questions when assigning points: o is the program/event free for residents of Atlantic Beach? o If there is a fee or cost, does the proposal describe steps to ensure that participants are not denied the opportunity to participate due to their inability to pay fees or costs? CDIS, if funded, will be offered at no cost to an. particii )ant. 7. Evaluating Success (Maximum 30 POINTS) Briefly describe how you will measure success. This should include how you will assess participant satisfaction, number of participants and (if applicable) changes in knowledge, attitudes, skills or behaviors. Describe data collection methods and who will be surveyed. Please also describe how data will be used to inform program improvement. NOTE: Reviewers will consider the following questions when assigning points: o Is there an adequate evaluation plan for measuring participation, participant satisfaction and (if applicable) changes in knowledge, attitudes, skills or behaviors o Will data provide actionable information for future planning? o Will results be useful for dissemination to the community? o Does evaluation include feedback from participants/audience as well as planners/ organizers and volunteers? JDT program managers will conduct formative and summative evaluations to collect data on student experience and program impact. Before and after surveys will elicit the thou thts, feelin_s, and experiences of the children who participate in CDIS workshops. A separate set of surveys will be handed out to classroom teachers to collect their observations of the classroom throughout the workshop. These surveys will then be collected, analyzed, and adapted into a summative, imat written report. 8. Resourcing (Maximum 15 POINTS) Please describe any plan to leverage additional resources (e.g. other funding, volunteers, in-kind donations) or collaboration with others to offset expenses NOTE: Reviewers will consider the following questions when assigning points: o is there a plan to leverage additional resources (other funding, volunteers, and/or in-kind donations)? o Is there collaboration with other organizations that will help to offset resources and expenditures? o Is this a for-profit event? Creative Dance in Schools is an arm of Jacksonville Dance Theatre's: Live The Arts program and is not a for-profit event. JDT will provide a 30% cash match at $1,000 to support the full implementation of CDIS. 0 $ 68.606 1 'JACKSONVILLE I a DANCE TH JACKSONVILLE DANCE THEATRE, INC. PROPOSEDANNUAL OPERATING_ W ... _. BUDGET 2020 (SEASON EIGHT) _..__. REVENUE Ticket Sales/Admissions Merchandise / Concessions Sales Private/Individual Donations Board Dues' Corporate Gifts/Grants Artist/Performance Fees (Contracted Services) Teaching Revenue Submission Fees (JDFF) Foundations Cultural Service Grant Program Division of Cultural Affairs Fundraising Event to -kind Rehearsal Space in-kind Graphic Design SUB TOTAL REVENUE TOTAL REVENUE EXPENSES Dancer Pay Admin. Pay Commissioned Choreography & Rites Production Staff & Crew / Costs Florida Theatre Office Space Venue Space Rental Insurance Professional Development General Office Suppiles (Internet, Website, Bank Fees Etc Merchandise Marketing, Advertising, Graphic Design Photography / Videography Costumes/Props Travel, Transportation Festival Submission & Participation Fees Fundraising Expense In -Kind Rehearsal Space (JU) In-kind Graphic Design (Studio Fuse) TOTAL EXPENSE BUDGET Q9 ACTUAL $ 11,000.00 $ 300.00 $ 7,500,00 $ 5,000.00 $ 5,000.00 $ 5,000.00 $ 1,000.00 $ 1,500.00 $ 2,500 00 $ 5,000.00 $ 2,806.00 $ 8,000,00 $ 10,000.00 S 4,000,00 02 ACTUAL Q3 ACTUAL — Q4 ACTUAL YTD ACTUAL VARIANCE $ 0.00 $ 11000 00 $ 0.00 $ 300.00 $ 0.00 $ 7,500,00 $ 0.00 $ 5000.00 $ 0.00 $ 5000.00 $ 0.00 $ 5,000.00 $ 0.00 5 1000.00 $ 0.00 $ 1,500.00 $ 0.00 $ 2,500.00 $ 0.00 $ 5000.001 $ 0.00 $ 2,606.00 $ 0.00 $ 8,000.00 0.00 $ 10000.00 $ 0.00 5 4000 001 5 69,6(-16 5 00. 5 •00 s -00 5 -00 5 64006 $ 69,6061 5 -00 L $ 1 5 -00 $ 16,000 00 $ -00 $ 2,806.00 $ -00 $ 3,000.00 $ -00 $ 5,000,00 $ -00 $ 2,597,00 $ -00 $ 1,000.00 $ -00 $ 1,954.00 . $ -00 $ 1,500,00 $ -00 $ 2,000.00 $ -00 $ 2,000.00 $ -00 $ 2,500,00 $ -00 $ 1,500.00 $ -00 $ 2,000.00 $ -00 $ 5,000.00 $ -00 $ 50.00 $ -00 $ 3,500 00 -- 5 -00 $ 10,000 00 5 -00 $ 4 000 00 00 $ ?6, $ 16'.Cj9000 $ 2,806.00 $ 3,000,00 $ 5,000,00 $ 2,597.00 $ 1,000.00 $ 1,954.00 $ 1,50000 $ 2,000.00 $ 2,000,00 $ 2,500,00 $ 1,500.00 $ 2,000.00 $ 5,000.00 $ 50.00 $ 3,500.00 $ 10,000.00 $ 4 000 00 .. 5 66,407 $ -00- $ -00 5 041" $ I 1 5 -00 $ 16,000 00 $ -00 $ 2,806.00 $ -00 $ 3,000.00 $ -00 $ 5,000,00 $ -00 $ 2,597,00 $ -00 $ 1,000.00 $ -00 $ 1,954.00 . $ -00 $ 1,500,00 $ -00 $ 2,000.00 $ -00 $ 2,000.00 $ -00 $ 2,500,00 $ -00 $ 1,500.00 $ -00 $ 2,000.00 $ -00 $ 5,000.00 $ -00 $ 50.00 $ -00 $ 3,500 00 -- 5 -00 $ 10,000 00 5 -00 $ 4 000 00 00 $ ?6, NET FROFIT/{LOSS) 2,199 1 $ _ppj$ 001 -00 $ 2,199 2 1 CDIS Atlantic Beach Program Budget EXPENSES Dance Teacher(s) Pay $2,400 Administrative/Stat Support $350. Data Collection/Surveys $50 Marketing + Promotion $200 Insurance Riders $1,000 TOTAL _----__---_------- _ $4,000 INCOME Atlantic Beach Grant Cash Match $3,000 $1,000 TOTAL $4,000 8/20/2019 iNTURNA.1 REv71717R SERv:cE ?. O. ROI 2e20 CiNCINNATI, C3 452C1 OCT 16 2014 .714.CX1001,n7=ZE DANCE THEATRE 7WC 132C LANbON AVE XiCXWONVILLZ- PI, 32207 Tear ApplIcamt: JDT Determination Letter 101614jpeg •7— DEPARTMEN1 OF THE TREAS7RY Employe,: Tdeneifaeation =chez! 46- I DLN: .3175345014 Contact Person: MARIA S TRITCR 704 11549 Cent -act Telephone Number! es -7) 029-EC00 Aoc:ountiop PerLed Eodig. July 31 Charity Statue, 170tb1(1):11) For 990 Reguired YCEI Effective Date of ExempLion- May 6, 2C13 Contribution DcductibilLLY Yes Addend= Applies - No We are pleased to ialorm you that upon -eview ot your application for tax extmet statua we have determined that you are exempt from Federal income tax o.ction c,:fc.):74: of the Internal Revenue Cede. CootriUtiOns to you are oOductible under tfen 17 of the COde- ¥ ore alae qualified tO receive max deduetdhle bequentn, devises.. Lxantzfero or gifts under section 2055. 210-6 or 26,221 of ..oe Code. Beceutae thit letter cou:d help resolve auy euentions your exempi. neatus, you sheald keep it in yolzf pertlanent recordn. Orgalilza•ions exempt under section 5.3:fe) 'A) of the code are Lurther 4n either oublir charities or private foundatIons- We determined that yotare a Ohart y uhder Lbe code sectiouun) listed in the nead,nq of this For important_ information about your responaihiIILle* au a tax-eimepL oration, go to www.its goviehariLien Frtcr "4221-2C" In the search bar to view Pub::cetion 4221 -PC. Ccepliance Guide for 01( (3) Public Cbaritiem, ceserlbes your recordkeepfna, repol-i-Ing, and diselonuze requfroments. Sincerely, F'pt OrgatizatiOco Let -ter .947 https://mail.google.com/maillu/0/?shva=1/1inbox/KtbxLwelQsQPITIOVcBrCfRdNxkR1M.11L?projector=18cmessagePartld=0.2 1/1 -JACKSONVILLE DANC H T Board of Directors Renee Favo (1st Term) P. 904.322.9317 E. TypeAplus@gmail.com GFWC Jacksonville Beach Women's Club Board Memner (2007-2019) Former Dancer, Musician + Artist Stephanie Natale Frus (chair) (2nd Tenn) 1230 Landon Avenue Jacksonville FL 32207 P. 904.607.6738 E. jdtsteph@gmail.com Director, Special Events Manager, Teacher/Curriculum Writer, Creative Writer Richard Graf (treasurer) (2nd Term) 13081 Harborton Dr. Jacksonville, FL 32224 P. 904.234.0113 E. riffraffivritin a mail.com Owner, riffraffwriting; Board member, The Jacksonville Online Marketing Meet -Up (JOMM) Pam Johnson (1st Term) 12820 Crusselle Dr Jacksonville, FL. 32223 P. 904.612.8125 E. pambridget@outlook.com Junior Leagues of Jacksonville, Denver and Northern Virginia; Jacksonville Member Event Planning Committee - Vice -Chairman Sustainer Advisor (2016 - present), Capital Campaign Committee 2016-2017 Rebecca R. Levy (ex -officio) (2nd Term) 2737 Downing St. Jacksonville, FL 32205 P. 949.887.1134 E. jdtrebeccata ,2mail.com Jacksonville Dance Theatre, Artistic Director & Co -Founder; Florida State College Jacksonville, Professor of Dance Hilary Libman (1st Term) 208 35th Ave S Jacksonville Beach, FL 32250 P. 646.379.8135 E. hilar .1ibman'ir�Ill e.com Founding Dancer, Jacksonville Dance Theatre; Former Artistic Director, Braided Light Dance Project; Pilates Instructor; Choreographer; Patron of Dance and Culture in Jacksonville Holly Deckerhoff Manuel (1st Term) 12867 Southern Hills Circle East Jacksonville, FL 32225 P. 904-662-5555 E. deckerhoff.manuel cm2.mail.com Current Manager, Facilities Marketing/CreativeworX at WJCT Studios; Former Assistant to the Executive Director and Board Liaison at The School of American Ballet at Lincoln Center, Development Associate at the Newark Museum, Recipient of the National Arts & Letters Society award Amani Mardini (1st Term) 3228 Prather Drive Jacksonville, FL 32216 P. 904.563-1136 E amanibmar a ;mail.com Event Planner, Restaurant and Bar Experience, Social Media Guru Holly Masturzo, Phd. (secretary) (1st Term) 236 Florida Blvd. Unit 2 Neptune Beach, FL 32266 P. 904.772.5667 E. hhnastri �2mail.com Professor of Humanities, Florida State College at Jacksonville Katie McCaughan (ex -officio) (2nd Term) 1625 Pershing Rd. Jacksonville, FL 32205 P. 206.427.7126 E. jdtkatie iL rnail.com Executive Director & Co -Founder, Jacksonville Dance Theatre; Former Director of Dance & English Instructor, Episcopal School of Jacksonville; Former Member, Any Given Child Jacksonville Steering Committee; Adjunct Professor of Dance at Jacksonville University and Florida State College at Jacksonville Advisor}/Communis. Board Peggy Burt 747 Canyon Crest Dr. Sierra Madre, CA 91024 Senior Advisor, Arts Planning Initiative. California Alliance for Arts Education. Coach, Los Angeles County Arts Commission: Arts for All. Facilitator, Open Stage: Pasadena Unified School District. NEA Funded Grant Project. Susan Masucci 1450 Flagler Ave. Suite 15 Jacksonville, FL 32207 P. 904.994.0448 E. susan�a7createaruckus.com principal, ruckus. advertising + public relations; Teach for America Jacksonville, Board member and Public Affairs committee member; Ritz Chamber Players, Board member; JBJ "40 Under 40" 2013; Leadership Jacksonville, Class of 2010 Paul Levy 59 Oxford Rd. Newton, MA 02459 E. plevy0808@gmail.com Senior Advisor, Lax Sebenius LLC; ISO -New England, Board member; Legal Sea Foods, board member; Jewish Community Housing for the Elderly, board member; MIT Hillel, board member. Erik Henderson 1220 American Eagle Lane Jacksonville, FL 32225 P. 904.228.3744 E. ehenderson425agmail.com CSX Technology, Manager, GIS Field Survey; National MS Society, Board of Trustees Form W-9 (Rev. 11-2017) Page 6 The IRS does not initiate contacts with taxpayers via emails. 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Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other Income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civic and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax retum. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information. State of Florida Chief Financial Officer Department of Financial Services Bureau of Accounting 200 East Gaines Street Tallahassee, FL 32399-0354 Telephone: (850) 413-5519 Fax:(850) 413-5550 Substitute Form W-9 In order to comply with Internal Revenue Service (IRS) regulations, we require Taxpayer Identification information that will be used to determine whether you will receive a Form 1099 for payment(s) made to you by an agency of the State of Florida, and whether payments are subject to Federal withholding. The information provided below must match the information that you provide to the IRS for income tax reporting. Federal law requires the State of Florida to take backup withholding from certain future payments if you fail to provide the information requested. Taxpayer Identification Number (FEIN): 46-5348863 IRS Name: JACKSONVILLE DANCE THEATRE Address: 128 E. FORSYTH ST SUITE 610 JACKSONVILLE, FL 32202-0000 Attention Of: KATIE MCCAUGHAN In Care Of: KATIE MCCAUGHAN Business Designation: Not For Profit Certification Statement: Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer information AND 2. 1 am not subject to backup withholding because: (a) 1 am exempt from backup withholding or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that 1 am no longer subject to backup withholding AND 3. I am a U.S. citizen or other U.S. person (including U.S. resident alien) Preparer's Name: KATIE MCCAUGHAN Preparer's Title: EXECUTIVE DIRECTOR Phone: 2064277126 Email: jdtkatie@gmail.com Date Submitted: 05/21/2019 Date printed from the State of Florida Substitute Form W-9 Website: 05/21/2019 To Whom It May Concern: This letter is to share my firsthand experience with Jacksonville Dance Theatre, Creative Dance in Schools program. Greenland Pines Elementary School was fortunate to have two teachers come from the program and share with two classes of each grades K, lst,2nd and 5th. While all experiences were similar care was given to present in an age appropriate way to each group. The activity was engaging and provided 'out of the box' educational experiences to bring academics into a new forum. Our students were excited about their experience and open to the different ideas and ways of responding to this program. We are thankful for the opportunity and hope that funding continues and will allow us to participate again in the future. Sincerely, Cindy Patton Music Specialist Greenland Pines Elementary School, #249 5050 Greenland Road Jacksonville, FL 32258 pattonc@duvalschools.org DUVAL CHARTER SCHOOL - ...�-atWestside April 28, 2017 To Whom It May Concern: My name is Tania Woods. I am the principal of Duval Charter School at Westside (DCSW). Since most of our students come from low socio-economic backgrounds, exposure to the arts is limited. DCSW is grateful to have partnered with Jacksonville Dance Theater two years in a row. Last school year, select students learned a dance and were exposed to the Waterways project participating at Jacksonville University. This year we had the opportunity to have Jacksonville Dance Theater come into our school and perform, reaching even more students, surrounding the Bridges Project. Students and teachers alike rave about the quality job Jacksonville Dance Theatre provided in not only dancing but also thoroughly explaining what they would be doing and aspects for students to look for. It is my hope that Jacksonville Dance Theatre has the opportunity to participate in future grants and continue to expose various students to the arts. Thank you for your time, consideration, and such a generous donation of time and talent. I look forward to continuing our partnership. If there are any additional ways Jacksonville Dance Theatre may support DCSW or we may support Jacksonville Dance Theatre, please do not hesitate to contact me. Sincerely, Tania Woods Principal, Duval Charter School at Westside 9238 103rd Street, Jacksonville, FL 32210 Phone: 904-421-0250 • Fax: 904-423-2601 www.westsidecharter.org A Member of the Charter Schools USA Familu of Schools.