Fiscal Sponsorship Disbursement Form Studio at 550 Posted on April 5, 2023 by calliechapmanApril 22, 2026 Fiscal Sponsorship Payment Disbursement Use this form as a fiscally sponsored artist to request funds from your account. Payment will be made within 5 business days of the request submission date. Name on file to disburse funds to (individual) First Last This is the entity to which the check will be written and who will receive a 1099 at the end of the year. Please be sure that this individual has both a contract and a W9 on file with us. Otherwise, we will not be able to issue the check.Name on file to disburse funds to (business/group)This is the entity to which the check will be written and who will receive a 1099 at the end of the year. Please be sure that this entity has both a contract and a W9 on file with us. Otherwise, we will not be able to issue the payment.Payment Method(Required) Check - Mailed via USPS to address on W9 EFT - through Nickel (new) Have you set up an EFT/Nickel account with Studio at 550 yet? Yes No Note: As of 12/31/25 Studio @ 550 has changed payment processors from Melio to Nickle. Once you fill out this form and we initiate payment you will receive a preliminary email to set up a vendor account by entering your payment details. Once we receive this information we can initiate payment through Nickel.Address to send the disbursement to Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Contact Email(Required) Additional contact email If there is more than 1 contact in your fiscal sponsorship agreement, email of both parties in the contract must be entered here. Both will receive correspondence about this notice and future disbursements.New process for year-end 1099 reporting (effective 12/31/25): Disbursement requests are now divided into two itemized sections based on IRS reporting requirements: 1099-reportable payments — payments to individuals for direct support, stipends, honoraria, or services Program expense reimbursements — reimbursement to individuals for documented, program-related expenses (not reported on a 1099) I am requesting funds for Payments to people (may be 1099-reportable) Reimbursement for documented project expenses(not 1099 income) select all that apply1099-REPORTABLE PAYMENTS(Direct Support / Stipends / Honoraria / Services) Use this section if you are requesting: Direct financial support Stipends or honoraria Payment for labor, services, or artistic work Funds not tied to specific receipts Date to be Disbursed (1099) MM slash DD slash YYYY Please note that a check will be written to the name/W9 that is on file within 5 business days of the 1st business day of receiving this request.1099 Payment AmountDescription of what the funds will be used forRequired Acknowledgement I understand that this payment may be reported as taxable income and that I am responsible for any taxes owed. PROGRAM EXPENSES (Non-1099)Reimbursement for supplies, materials, or other approved program costs you already paid Advance for project expenses based on quotes (funds will be spent for approved program purposes; receipts must be submitted afterward) Date to be Disbursed (non 1099) MM slash DD slash YYYY Please note that a check will be written to the name/W9 that is on file within 5 business days of the 1st business day of receiving this request.Payment Amount (non 1099)Include what was purchased and how it supports the project.(Required)Quote/Receipt Upload Drop files here or Select files Max. file size: 256 MB. If submitting a reimbursement, upload receipts for expenses already paid. If submitting a project expense advance, upload quotes for expected expenses. Receipts must be provided after purchase. All documents should clearly show the item, cost, and vendor (or description for services/materials). Certification: I certify that these expenses were incurred solely for approved program purposes, were not personal expenses, and are being submitted for reimbursement only. If these funds were received through a grant, please name the grant and funder.ConfirmationConfirmation I confirm that I am authorized to request disbursement of funds from this fiscal sponsorship account. I confirm that the requested funds will be used only as described and in accordance with my fiscal sponsorship agreement. Receipts/Unused Funds Acknowledgement I certify that any program expense reimbursements or advances will be used solely for approved program purposes, and I will provide receipts for expenses or return any unused funds. Payments for 1099-reportable items (direct support, stipends, honoraria, or services) and program expense reimbursements or advances will be issued as separate disbursements. This ensures accurate accounting and proper year-end IRS reporting. Δ
