CCHA | Application

CCHA Community Incentive Program Application

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Information requested from application:

Applications must include the following information submitted using the form below. If you have questions about the application, please contact PIAC@CCHAcares.com.

Community Incentive Application Form PDF: Click Here to Open / Download

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. *