Partnerships For Change® Application for Fiscal Sponsorship Project Title Applicant (Project Director):* Applicant's primary role on this project: Producer Director Producer/Director Co-Producer Co-Director Email Provide a primary email to receive communication about your application here. Must be an address you check regularly. Address Choose Country Afghanistan Aland Islands (Finland) Albania Algeria American Samoa (USA) Andorra Angola Anguilla (UK) Antigua and Barbuda Argentina Armenia Aruba (Netherlands) Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda (UK) Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands (UK) Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands (Netherlands) Cayman Islands (UK) Central African Republic Chad Chile China Christmas Island (Australia) Cocos (Keeling) Islands (Australia) Colombia Comoros Cook Islands (NZ) Costa Rica Croatia Cuba Curacao (Netherlands) Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (UK) Faroe Islands (Denmark) Federated States of Micronesia Fiji Finland France French Guiana (France) French Polynesia (France) Gabon Gambia Georgia Germany Ghana Gibraltar (UK) Greece Greenland (Denmark) Grenada Guadeloupe (France) Guam (USA) Guatemala Guernsey (UK) Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong (China) Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man (UK) Israel Italy Ivory Coast Jamaica Japan Jersey (UK) Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau (China) Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique (France) Mauritania Mauritius Mayotte (France) Mexico Moldov Monaco Mongolia Montenegro Montserrat (UK) Morocco Mozambique Namibia Nauru Nepal Netherlands New Caledonia (France) New Zealand Nicaragua Niger Nigeria Niue (NZ) Norfolk Island (Australia) North Korea Northern Mariana Islands (USA) Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands (UK) Poland Portugal Puerto Rico Qatar Republic of the Congo Reunion (France) Romania Russia Rwanda Saint Barthelemy (France) Saint Helena, Ascension and Tristan da Cunha (UK) Saint Kitts and Nevis Saint Lucia Saint Martin (France) Saint Pierre and Miquelon (France) Saint Vincent and the Grenadines Samoa San Marino Sao Tom and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Netherlands) Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen (Norway) Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau (NZ) Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands (UK) Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Virgin Islands (USA) Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna (France) Western Sahara Yemen Zambia Zimbabwe Phone Number Logline - Provide a 1 to 2 sentence descriptive summary of the overall story you plan to tell. The logline should capture the essence of the documentary with the intention of making the reader want to read and see more. Total Project Budget in US Dollars (example - $300,000) Amount of funding to date in US dollars (example - $25,000)List funding sources and amounts provided to date. Use separate line for each source and separate the source name and amount with a comma (example - Pacific Pioneer Fund, $3,000) Current Stage of Production Choose One: Development Pre-Production Production Post Production Distribution/Outreach I. Proposal - upload your proposal in pdf format. A detailed description of the required proposal elements can be found at www.documentary.org/sponsorship/applyII. Budget - upload your budget in pdf format A detailed description of the required budget elements can be found at www.documentary.org/parelorentz/applyIII. Letters of Support or Supplemental Material. (optional) IV. Sample Work - provide the URL to view your sample work. A sample work is not required. For more details visit www.documentary.org/sponsorship/applySample work password (optional) If your sample work requires a password to view, provide it here. Vimeo passwords are case sensative.Statements of Agreement Read and select "I agree" belowi. The enclosed application (“Application”) and all of the information submitted in connection therewith to the Partnerships For Change® (PFC®) is accurate; I agreeiii. PFC® is not responsible for loss or damage to the Materials, or for any misuse by any third party unless done under PFC®'s express direction or authorization; I agreeiv. I own or control all of the Materials and all right title and interest including copyright of the film or project described in the Application (the “Project”). I agreev. The Project and the Material are wholly original with me and do not infringe upon, violate the rights or constitute a libel, slander, or an unfair competition against, or infringe upon or violate the copyright, common law rights, or literary, dramatic, photoplay rights or privacy or publicity, or any other rights of the person, firm, corporation or other entity. I agreevi. I have read and understand the guidelines and eligibility requirements at www.partnershipsforchange.com/*** and to the best of my knowledge am eligible to apply to PFC®'s Fiscal Sponsorship Program with the Project described in the Application. I agreePlease Answer the Following Math Question: 5 + 3 is Powered by ChronoForms - ChronoEngine.com