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Community Impact Grant Program Form

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Community Impact Grant Program Information

Valley County Community Impact Grant Award Agreement

Contact Informaiton

*First Name

*Last Name

*Contact Email address

*Contact Phone

*Contact Address

*Contact City

*Contact State

*Contact Zip Code

Organization Name

Organization Information

*Organization Name

*Address

*City

*State

Zip Code

*EIN

How much funding are you requesting?

*Have you applied for Valley County funds before?

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

Brief overview of grant detail application.

*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.

*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 indicate the grant request amount.

Would you like the funding distributed in a one-time payment or two equal payments?

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

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

*Electronic Signature (Type Your Full Name)

Confirm

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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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