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What We Fund
Apply for Funding
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
*
Email
*
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
*
SUBMIT