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Valley County Idaho

Community Impact Grant Program Form

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Community Impact Grant Program Information

Contact Informaiton

*First Name

*Last Name

*Contact Email address

*Contact Phone

*Contact Address

*Contact City

*Contact State

*Contact Zip Code

Organization Name

*Organization Name

*Address

*City

*State

Zip Code

*EIN

*Have you applied for Valley County funds before?

If yes, how much did you receive and for what purpose?

*Describe your project or program.

*How will this project benefit the Valley County community as a whole?

Explain the need for funding from Valley County.

*Detail how funds will be used, including a timeline of activities and expected expenditures.

How funds will be used: File Upload

*What measurable outcomes or impacts do you expect?

*Do you have other sources of funding or in-kind support?

*What happens if partial funding is awarded?

*Are you willing to provide a 15-minute presentation to the review committee?

*Will you provide a final report summarizing use of funds and outcomes?

Please upload the following:

*Detailed budget (provide template or example)

*A list of your current board members

*Most recent Profit & Loss statement

*Proof of IRS 501(c)(3) status

*Idaho Secretary of State Proof of Entity

Idaho Code SECTION 28-50-107
LEGAL RECOGNITION OF ELECTRONIC RECORDS, ELECTRONIC SIGNATURES AND ELECTRONIC CONTRACTS — ELECTRONIC TRANSMITTAL IN LIEU OF CERTIFIED MAIL.

A record or signature may not be denied legal effect or enforceability solely because it is in electronic form.
A contract may not be denied legal effect or enforceability solely because an electronic record was used in its formation.
If a law requires a record to be in writing, an electronic record satisfies the law.
If a law requires a signature, an electronic signature satisfies the law.
If a law requires any notice or other record to be sent by certified mail, the record may, with the express consent of the recipient, be transmitted electronically.

*I have read and understand all writing on this page. All information is true and accurate.

*Electronic Signature (Type Your Full Name)

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General Information

Staff Directory

commissioners@valleycountyid.gov

Contact Info

Valley County, Idaho
219 N. Main Street
PO Box 1350
Cascade, ID 83611

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