Please fill out the following information and it will automatically be entered on our official cover sheet. Once you have completed the form, click "Download Packet" for your customized CHC Grant Packet

Project Information
Grant Project

Amount Requested from CHC
$ 
Your Matching Funds
$ 
Project Location

County

Brief Description of what the GRANT MONEY would be used for

 
Organization Information
Name of Organization

Project Main Contact

Phone (Day)

Phone (Evening)

Email Address

 Additional Contacts who may be contacted regarding this project
   Contact Name
   
   Phone (Day)
   
   Phone (Evening)
   
 
Applicant Organization Information
Applicant Organization (501 (c)(3) tax exempt holder - Verification will need to be attached)

Organization Contact (All formal correspondence will be mailed to this contact)

Org. Contact Phone (Day)

Org. Contact Phone (Evening)

Mailing Address

City

State

Zip

Brief Description of Organization