LINCS 2008 APPLICATION FORM: PART I

Please read all instructions carefully to ensure that your application is processed!

Please submit Part I of your application online. You will be given an opportunity to review the information you enter and make changes if needed. Upon submitting Part I electronically, you will be prompted to print and sign the application form and use it as the cover sheet when submitting the remainder of your materials.

Before completing this form make sure you have read the LINCS 2008 Guidelines and How to Apply.

Enter all applicable information below and select Proceed to Confirmation when finished. Asterisks (*) indicate required fields.

PROGRAM INFORMATION


Program Title*


Brief Summary of Proposed Program* (25 words or less)


Length:*
1/2 Hour Hour Feature

Genre:*

Documentary Docudrama Experimental

Animation Other

If Other, please specify:


Shooting Format:*

BETA DV HD

16 mm 35 mm Other

APPLICANT INFORMATION

Name of Applicant* First: Last:
Role in production:* Director Producer Director/Producer Co-Director Co-Producer Co-Director/Co-Producer Name of Production Entity (if applicable)
Address*
City*	State* AL AK American Samoa AZ AR CA CO CT DE DC FL GA Guam HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA Puerto Rico RI SC SD TN TX UT VT VA Virgin Islands WA WV WI WY	Zip*
Phone 1*		Type* Home Cell Work
Phone 2		Type Home Cell Work
Email Address*		Fax

BACKGROUND INFORMATION FOR REPORTING PURPOSES ONLY

Ethnicity:

African American Arab American Asian American European American

Latino/Latina Native American/Native Alaskan Pacific Islander Other

If Other, please specify:


Gender: Female Male Decline to State

Age: 18 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 and older Decline to State

Other community:

LGBT Disability Other

If Other, please specify:


How did you hear about LINCS?
Word of Mouth Internet Search ITVS Website ITVS Seminar or Workshop Media Arts Organization Beyond the Box Trade Publication Market Festival ITVS Community Screening ITVS E-mail/Staff Referral Other

If Other, please specify:



CO-APPLICANT INFORMATION

Name of Applicant First: Last:
Role in production: Director Producer Director/Producer Co-Director Co-Producer Co-Director/Co-Producer Name of Production Entity (if applicable)
Address
City	State AL AK American Samoa AZ AR CA CO CT DE DC FL GA Guam HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA Puerto Rico RI SC SD TN TX UT VT VA Virgin Islands WA WV WI WY	Zip
Phone 1		Type Home Cell Work
Phone 2		Type Home Cell Work
Email Address		Fax

BACKGROUND INFORMATION FOR REPORTING PURPOSES ONLY

Ethnicity:

African American Arab American Asian American European American

Latino/Latina Native American/Native Alaskan Pacific Islander Other

If Other, please specify:


Gender: Female Male Decline to State

Age: 18 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 and older Decline to State

Other community:

LGBT Disability Other

If Other, please specify:


PUBLIC TELEVISION STATION INFORMATION

Public Television Station* Alabama Public Television ALASKAONE (KTOO) ALASKAONE (KUAC) ALASKAONE (KYUK) Arkansas Educational Television Network Blue Ridge PBS CET Channel 43 - Oklahoma City CMU Public Broadcasting Community Idea Stations Connecticut Public Television Delta College Quality Public Broadcasting, QTV Detroit Public Television East Tennessee Public Television Eight/KAET Georgia Public Broadcasting Houston PBS Idaho Public Television Iowa Public Television KACV KAKM KAMU KBDI KBTC KBYU-TV KCET KCOS KCPT KCSM KCTS KCWC/Wyoming Public Television KEDT KEET Kentucky Educational Television KENW KERA KETC KGTF KIXE KLCS KLRN KLRU KMBH KMOS KNCT KNME KNPB KOCE KPBS KPBT, Permian Basin PBS (KOCV) KPTS KQED KRCB KRSC KRWG KSMQ KSPS KTEH KTSC (Rocky Mountain PBS) KTWU KTXT KUAT KUED KVCR KVIE KVPT KVZK KWBU KWSU KYVE Lakeland Public Television Lakeshore Public Television Louisiana Public Broadcasting Maine Public Broadcasting Network Maryland Public Television MHz Networks Michigan Television Milwaukee Public Television Mississippi Public Broadcasting Montana PBS Mountain Lake PBS Nashville Public Television Nebraska Educational Telecommunications New Hampshire Public Television New Jersey Network NYC TV 25 OETA Oregon Public Broadcasting Ozarks Public Television PBS 45 & 49 PBS Hawaii Pioneer Public Television Prairie Public Television Public Broadcasting Atlanta Puerto Rico Public Broadcasting Rhode Island PBS Rocky Mountain PBS Smoky Hills Public Television South Carolina ETV South Dakota Public Broadcasting Southern Oregon Public Television Think TV Thirteen/WNET Twin Cities Public Television UEN-TV UNC-TV Vegas PBS Vermont Public Television WBCC WBGU WCEU WCNY WCTE WDSE WEDU WEIU West Virginia Public Broadcasting Western Kentucky University Public Broadcasting WETA WFSU WFWA WFYI WGBH WGBY WGCU WGTE WGVU WHRO WHUT WHYY WILL WIPB Wisconsin Public Television WITF WJCT WKAR WKNO WLAE WLIW WLJT WLRN WLVT WMFE WMHT WMTJ WNED WNIN WNIT WNMU-TV WOSU.TV WOUB-TV WPBS WPBT/Channel 2 WPSU - Penn State Public Broadcasting WQED WQLN WQPT WSEC-TV WSIU WSKG WSRE WTBU WTCI WTIU WTJX WTTW WTVI WTVP WUFT WUSF WUSI WVIA WVIZ/PBS WVPT WVUT WXEL WXXI WYBE WYCC WYES
Designated Station Contact* First: Last:
Title*
Address*
City*	State* AL AK American Samoa AZ AR CA CO CT DE DC FL GA Guam HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA Puerto Rico RI SC SD TN TX UT VT VA Virgin Islands WA WV WI WY	Zip*
Phone 1*		Type* Home Cell Work
Phone 2		Type Home Cell Work
Email Address*		Fax

INFORMATION ON SUPPORTING VIDEO MATERIALS


Work-in-Progress 4 copies (required)

Type:*
Trailer Selects Rough Cut

Length*


Work-in-Progress Format:*
DVD PAL DVD NTSC VHS PAL VHS NTSC


Previously Completed Work Sample 1 copy (required)

Title:*


Length*


Format:*
DVD PAL DVD NTSC VHS PAL VHS NTSC

Role:*
Producer Co-Producer Director Co-Director

BUDGET SUMMARY


Station In Kind*


Cash Spent to Date*

Cash Secured Not Yet Spent*

Description

Pending Funds*

Description

Total Request to ITVS*


Total Budget of Program*






Once all of the information above is complete and correct, you must: