Community Grant Application

Company / Organization name

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Project Title

Total amount requested

Overview of project

Statement of need: How does this grant help Harper County's health and wellness?

Target population served by project:

Budget: Provide details of expected expenses to request. If needed, upload a document to show the budget.

Budget:

Will you receive other grants or funds for this project?

If yes, how much and what is the source of funding?

What will be the impact if partially funded or not funded?

If selected, I understand that our group will provide progress monitoring reports two times a year and a final report once the grant is complete.

If selected, I understand that HCHF would like to work with your group to appropriately display our logo.

If selected, we will provide photos of the project for HCHF's social media use.