CACHF Grant Application

Legal Name of your Non-Profit Organization(Required)

Address(Required)

Street Address City State ZIP Code

Authorized Contact Person(Required)

Title(Required)

Phone(Required)

Email(Required)

Type of Organization(Required)

Year Founded(Required)

Total Current Operating Budget(Required)

Primary Source of Funds(Required)

Total Project Cost(Required)

Number of People Served by Project(Required)

Project Time Period(Required)

Geographical Areas Served(Required)

Sources of Other Funds to Support Project(Required)

Grant Amount Request(Required)

Short Summary of the Project and Grant Request(Required)

Signature(Required)