ART FOR HEALING APPLICATION

ART FOR HEALING

GRANT APPLICATION

1. INSTITUTION INFORMATION

Name:_________________________________________________________________________

Type of institution: hospital___clinic___hospice___alternative healing center___private___

corporate___non-profit organization___local government___

Address:_______________________________________________________________________

Telephone:____________________ Fax:____________________

2. CONTACT PERSON

Name:_______________________________________ Telephone:________________________

3. PROJECT DESCRIPTION

Prospective location of artwork, general use of space, approximate wall space, etc.

______________________________________________________________________________

4. LIST OF PREFERRED ARTWORKS

List number, medium and size of artwork (click on thumbnails for this information)

______________________________________________________________________________

Note: Not all of the artworks on the web site are available for grant purposes, but every effort will

be made to match the choices. Framing where necessary and shipping costs must be assumed by

the recipient of the artwork.

How did you hear about ART FOR HEALING? ___________________________________________

I certify that all statements made in this application are true to the best of my knowledge.

Name: (please print)______________________________________________________________

Signature: _________________________________________Date:________________________

Send completed application and supporting material to:

ART FOR HEALING

Post Office Box 583

Accord, NY 12404