Grants

Funding Request Application

Completed application must be returned April 30th, 2021 by 4:00 PM to be considered. Attach additional sheets and supporting documentation, if necessary.

Organization Information

Name of Organization/Business applying for funds

Name of person completing this application

Title

Contact information for questions and follow up: Phone

Address

City/State/Zip Code

Status of your organization/business
Profit Non-Profit

Non-Profit IRS code

Amount

Amount of funding requested

Would partial funding be acceptable?
Yes No

Request

Describe the purpose of this request (what type of purchase/project)

Please list other sources of funding

Number of people in our area who will be affected by this purchase/project

Projected date that equipment will be in use or project will be completed

Why do you feel this purchase/project is important to the present and/or future health of the citizens of this area?

Supporting Documentation

Supporting Documentation 2

Supporting Documentation 3