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
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CiNCINNATI,
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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
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that will be used to determine whether you will receive a Form 1099 for payment(s) made to you by an agency of the
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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.