Eugene Lang Bursary Form Eugene Lang BursaryI am a member of the QACI am a member of the QACYesNo We are a school or classroom within Hastings and Prince Edward CountiesWe are a school or classroom within Hastings and Prince Edward CountiesYes Applicant's First Name Applicant's Last Name Address Line 1Address Address line 2 City State / Province / Region Postal Code Phone Email Group/School Name A brief but detailed description of the project Or upload your project descriptionAges and grades of students participating Artist(s) names Date(s) of workshops Number of students participating Number of audience reached A project budget outline Or, upload your project budgetFollow-up plan for evaluations/report Or, upload your follow-up evaluation/report planShould this project receive funding from the QAC I agree to the following: *Should this project receive funding from the QAC I agree to the following: *Invite members of the QAC to attend performance/exhibition/workshop.Provide a written summary and photos that can be used by the QAC for publication and grant purposes.Funds from the QAC are for artists fees. Payment will be made to the school ONLY upon receipt of the artist’s invoice, summary and photos. 4 + 7 = Submit
