Apply — Community Health Foundation of Warren and Henderson Counties

The Foundation provides planning, operating, capital, and project grants. To be eligible for a grant, applicants must be classified by the IRS as tax-exempt, nonprofit organizations.

Foundations can be most effective by concentrating their resources in a few areas. This means we cannot support many worthy projects outside our program interests or two-county area.

CHFWHC GRANT APPLICATION

Please use the following form to submit your application.  If you prefer, you may mail in a paper application.  If doing so, please use the same application format as follows.

Fields marked with * are required. It may be easier to write your application in a Word (or other) document and then copy and paste.

Organization Name

Contact Person

Enter the name of the contact person

First Name

Last Name

Email address

Mailing address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

What number can we call with questions?

(###)

###

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Amount of your grant request

Project Description

Describe a) what the request is for, b) what the objective is and c) who will benefit.

Project Implementation and follow-up

Provide a time-line for project initiation and completion and any key interim steps. Describe what follow-up assessments (if any) will be made and how project success will be measured once the project is completed.

Project budget

If applicable, please break down your request into key budget components. Identify what other funds (if any) are being utilized, including your own organization or other donors. Indicate whether the project will entail additional requests for Foundation funding in future years.

Additional information

Provide any other information you feel would be helpful for the Foundation Board to know about.

Upload Supporting Documents (if any) UPLOAD

If you wish to attach supporting documents to your grant request or an expanded grant request that is larger than what you were able to enter in the above fields, click the yellow "Upload" button and a DropBox window will open in a separate window (be sure you and your browser allow pop-ups) You may drop your attachments in the DropBox window. You may also upload a copy of your IRS not-for-profit letter but it is not required at this time.