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Grant Application


Name of Organization:_________________________

Name of Contact Person:_______________________    


Phone & Email:________________________________

Non-Profit, 501c(3) Tax Identification Number:____

Project Information

1. What dollar amount are you requesting?

2. How will these funds be used? (Please use additional pages if needed)

3. How many persons in Shelby County will this grant help serve?

4. What hardships would you face if these funds were not received?

5. What funds have you received from previous years?

6. What specific items have you purchased with those past funds?

7. Have all the past funds been used or are there reserve funds?

8. Have you applied for any other grants this past year? If so, how much did you request?

9. Any additional information you wish to add?


Please mail, fax or email completed application by September 15:

Shelby County Community Chest

PO Box 527

Harlan, IA 51537

SCCC Grant Application


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