WISCONSIN ARTS BOARD

GRANT REVISION REPORT

Instructions:  If the range of activities in your Wisconsin Arts Board award changes substantially from the originally proposed budget and narrative, then complete this form and return it to the Wisconsin Arts Board.  

Part I	

Grantee Name ___________________________________ Grant Number _______________

Project Title or Purpose for which funds were requested:  _____________________________

___________________________________________________________________________

Contact Person ___________________________________ Phone _____________________

Contact Person’s Email ________________________________________________________

Part II	

Indicate the circumstances which have led you to revise the project’s activities and budget.  Outline the changes to the project’s activities and budget that will now occur.  

Prepared by (Print) ____________________________ Title __________________________

Signature ____________________________________ Date __________________________