CCHA | Application

CCHA Community Incentive Program Application

Email Address *

Completed Community Incentive Application Form (Please download application form above) *

Non-discrimination Policy *

Current W-9 *

Most recent annual statements (audited if available) *

Current operating budget *

A detailed budget of this project *

A list of other sources of actual and expected funding, including amounts *

A copy of your current IRS determination letter indicating tax-exempt status, if applicable

Any additional supporting attachments

I attest that I have read and understand the application requirements, eligibility, exclusions, and funding terms. *

I attest that all information included in this application is complete, true and correct at the time of submission. *