CCHD Local Grant Application

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General Information
Name of Organization*
Mailing Address*
City, State ZIP Code*
Phone Number*
Amount Requested*

Contact Information
Name of Contact*
Contact phone*
Contact Email Address*

Questions regarding grants
Has this organization received a CCHD Local Grant in the past?*	Yes No
If Yes, what years and in what amount?
What other means does thie organization have for raising the necessary funds?*
Project Information Please give a project description of no more than 1000 words addressing the following questions: What is the goal of the project or organization? // What problem is it addressing? What will you be able to do with this grant that you would not be able to do otherwise? How many people do you estimate will be helped by this program? In what ways? To what extent, if any, do the beneficiaries have policy and decision making opportunities? In addition, please include a budget of no more than one page in length.
Project Description (1000 characters or less)
OR Attached a Word Document or PDF containing your project description by using the field below.
Grant Application and Budget PDF*
To prevent spam, please tell us: What is the sum of five and nine?*

General Information