Click on the PDF to the right to fill out the
grant application using Acrobat.
SHELBY COUNTY COMMUNITY CHEST
Name of Organization:_________________________
Name of Contact Person:_______________________
Phone & Email:________________________________
Non-Profit, 501c(3) Tax Identification Number:____
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