Emergency Fund

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Category of Si-Yo Artist™*

Si-Yo Master Artist™
Si-Yo Artist™
Si-Yo Young Artist™

List of Performance/Booking Cancellations due to COVID-19*

Click on the plus sign to the right of each row to add more entries

Name of Engagement	Date (dd/mm/yy)	Type of Engagement	Work(s) to be Performed	Performance Fee Contracted	Performance Fee Received	Out-of-Pocket Expense Contracted	Out-of-Pocket Expense Received	Unreimbursed Balance Amount

Total Grant Amount Requested*

Attach contracts for performances and any other evidence of fees agreed to, together with the related cancellation notices and related receipts for contractually provided reimbursement of out-pocket-expense, if any, that were not reimbursed or refunded*

May include screen shots of texts or emails

Drop files here or

Statement of Financial Need*

Including a statement that the requested COVID-19 Emergency Grant amount has not otherwise been offset by other sponsors or grantors

Confirmation that the requested COVID-19 Emergency Grant amount has not otherwise been offset by other sponsors or grantors*

I confirm.

Statement of Compliance/Non-Disqualification*

Disclose any relationship that would cause Applicant to be a disqualified person with respect to Si-Yo Music within the meaning of Section 4946(a) “Definition of Disqualified Person” of the Internal Revenue Code, and information on relationships between Applicant and (1) officers or trustees of Si-Yo Music, (2) donors to Si-Yo Music or a member of the family of either, and (3) a corporation controlled by a donor to Si-Yo Music (type “None” if there is no relationship).

Statement of Compliance with IRC Sec. 4946(a)*

I confirm that I have disclosed above to the best of my knowledge (1) any relationship that would cause Applicant to be a disqualified person with respect to Si-Yo Music within the meaning of Section 4946(a) “Definition of Disqualified Person” of the Internal Revenue Code, and (2) information on relationships between Applicant and (i) officers or trustees of Si-Yo Music, (ii) donors to Si-Yo Music or a member of the family of either, and (ii) a corporation controlled by a donor to Si-Yo Music.
I confirm that I do not have any relationship that would cause me to be a Disqualified Person under the Internal Revenue Code.

COVID-19 Community Outreach Commitment*

I agree that by submitting this Application, the undersigned Applicant agrees to participate in a Si-Yo Music approved COVID-19 community outreach program at a mutually agreeable time starting within 2 weeks after the date that a Grant under this Application is made to Applicant, or such other date as Si-Yo Music may approve.

By submitting this Application, the undersigned Applicant confirms that the foregoing information is true and complete to the best of his or her knowledge.*

I confirm.

Signature of Applicant (Parent/Guardian if Applicant is under 18)*

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Si-Yo Artist™ Support Fund COVID-19 Emergency Grant Application

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