Louisiana Cultural Assests Rescue

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Items marked with an * are required.

Business Name: *

Contact Name: *

Address: *

City: *

State: *

Zip: *

Phone Number: *

Email: *

Website:

What type of business do you operate?: *

What is your business’ primary focus?: *

Cultural Discipline of Business:
Check all that apply: *

Dance
Design Arts
Folk Life
Literature
Multi-Discipline
Culinary

Media
Music
Theatre
Visual Arts and Crafts
Preservation

What is your business’ tax structure?:

Sole proprietorship
Partnership

Limited Liability Corporation
Corporation

Do you own or rent your facilities?: *

OWN
RENT

Was it damaged by the hurricane(s)?: *

YES
NO

If yes, give the estimated facility damages in $:

Was there damage to inventory?: *

YES
NO

If yes, give the estimated inventory damages in $:

Has your business address changed since the hurricane?: *

YES
NO

What was your business’s total operating budget for last year?:

Total Income: *

Pre Hurricane

Post Hurricane

Total Expenses: *

Pre Hurricane

Post Hurricane

Number of paid staff (pre hurricane): *

Number of paid staff (post hurricane): *

How would you rate your organizational capacity in the following areas post hurricane?:

marketing/promotion
production/supplies
facility/studio/work space
equipment
storage
documentation of work
business records
performance/screening opportunities
sales/commissions/exhibition opportunities
cash flow/business loans
income
identifying and securing staff
public participation in programs
technology capacity
facility development and management
partnership and collaboration
financial management and planning
engagement with new work
retaining qualified associates
evaluation
other:

Does your business have any collaborative partnerships or arrangements with other organizations (non-profit or for-profit)?:

K-12 school groups
Arts organization

University arts organization
For profits

Other:

If yes describe.:

How has the hurricane affected the relationship?:

Have you received hurricane relief assistance? If so, how much and from which agency?:

	FEMA
	Small Business Administration
	Others(charities, foundations)

Are you insured?: *

YES
NO

Is your coverage adequate to recover losses?: *

YES
NO

What is your greatest cultural need at this time?: *