VIRGIL THOMSON  FOUNDATION, LTD.

Application Form

Please print or type.

Please fill in the following information.  Submit this sheet with all other application materials in one package and send to:

Grants Manager, Virgil Thomson Foundation, 254 West 31st Street, 15th Floor, New York NY 10001.  The postmark deadline for submission of applications is January 31.

Name of applicant organization:__________________________________________________________________________________

Address:____________________________________________________________________________________________________

___________________________________________________________________________________________________________

Phone Number:_______________________________________________  Email: _________________________________________

Contact Person:_______________________________________________  Fax: ___________________________________________

Chief Executive Officer:________________________________________________________________________________________

Type of organization:____________________________________________Date Founded:__________________________________

Name of organization as it appears on your IRS letter confirming tax exempt status under Section 501(c)(3) of the Internal Revenue Code:  ___________________________________________________________________________________________________________

Are you applying for general operating support or for a special project? __________________________________________________

Total amount of this request                                                                                              $ _______________

If you are applying for project support, what is the total cost of the project?          $ _______________

Brief description of the project __________________________________________________________________________________

___________________________________________________________________________________________________________

Applicant’s current fiscal year: Ending Month:_________________ Year: _______

Total actual expenses of current fiscal year: $_______________________

Applicant’s next fiscal year: Ending Month:__________________     Year: _______

Total projected expenses of next fiscal year: $_______________________

Previous grants from the Virgil Thomson Foundation during the last 3 years (include year of grant and amount and type of support, i.e., general operating support or project support)

For performing and presenting organizations: please list works by Virgil Thomson that applicant has programmed during the last five years or for the current or next season and indicate the year of each performance. __________________________________________

Please indicate the size of your audience each year for the last three years: ________________________________________________

Date application is being submitted:_____________________

A computer-generated version of this form is acceptable as long as all of the above information is provided.       Rev. 04/12/08