The EASL Fund provides limited financial assistance to North Texas visual artists and arts professionals who are in dire temporary distress because of an unforseen medical emergency or other catastrophic event.
 

Name __________________________________________________________

Address ________________________________________________________

City ____________________________ County _________________________

State ________ Zip __________________

Phone (daytime) ___________________________________

Phone (evening) ___________________________________

Social Security Number ________________________

The maximum grant available is $1,500 per emergency, or $3,500 for major medical emergencies annually. The EASL Fund is restricted to visual artists and visual arts professionals who have lived in Dallas, Tarrant, Collin, Denton, Parker, Johnson, Ellis, Kaufman, Wise or Rockwall counties for a minimum of two years and are pursuing a fine art career as evidenced by a record of exhibiitions and/or significant involvement in the North Texas arts community.

All questions must be answered completely and all requested materials enclose in order for your application to be evaluated.

What is the nature of your emergency?
 
Limit your description to the space below. Attach documentation where possible or appropriate (i.e. doctor/hospital bills, police report, eviction notices, utilities notice, newspaper article, etc.).
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 

 

Date of emergency ______________________
 
 

Estimate of total amount needed to recover, pay bills, etc.   $ _________
  
  

How much money are you requesting from the EASL Fund?   $ _________
 
 

Communities Foundation prefers that checks be written to service providers. List in priority those who would receive payment from your grant.
 
Check written to

Amount

Service provided
 
 
Employed? ___    Full-time ___    Part-time ___    How long? ________ 
 
if yes, list current employer, name, address, phone number. If no, list last employer and ending date of last employment.
 
 
 

List all sources of income.
 
 
 
 
 
 

What other grants or funding (i.e. insurance, fundraising efforts, etc.) have you received related to this emergency.
 
 
 
 
 

We may require proof of your financial status and/or residency (driver's license, voters registration card, etc.) Is such documentation available? If not, please explain.
 
 
 
 
 

List three references who would know about your current situation. Include their addresses, telephone numbers and your relationship to them.
 
Name                     Address                          Phone Number                Relationship
 
1. 
 
 
 
 
2. 
 
 
 
 
3.
 

List at least one professional reference who can verify your status as a visual arts professional.
 
 
 
 
 

Is there someone we may contact on you belaf if we are unable to reach you? List name, address, phone number and relationship.
 
Name                     Address                          Phone Number                Relationship
 
 
 
 
 

In order to better serve our community, we are interested in knowing how you learned about EASL.
 
 
 
 
 

As documentation of your professional status and exhibition history, please enclose your resume.
 
 
 
 
 

Signature of applicant

_____________________________________________  Date ____________

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