Grant Application

Please fill out the following:

Spring Deadline:

Submit Application by March 30th

Awards announced by May 30th

Fall Deadline:

Submit by September 30th

Awards announced by May 30th

Name *

First

Last

Phone Number *

Email *

Name/Title of Request *

Which pillar does your request fall under? *

Areas of Dodge County benefitted *

Project Location/Address *

Amount Requested *

Summary of Request *

Project Budget *

Estimates and bids for project work *

Please email project estimates or bids to [email protected] in PDF format.

Timeframe *

ex: Project completed in 6 months after funding

How does this benefit Dodge County? *

I agree to the following statement: *

I (or we), the applicant, agree to indemnify, defend, and hold harmless DCCF, its board of directors, officers, and its agents from and against any liability or loss arising from this application, any grant award should one be forthcoming to applicant, agreements arising out of such a grant, and/or ongoing engagement with DCCF, unless such liability or loss is the result of DCCF's sole negligence or willful misconduct.

I agree to: *

Authorization of DCCF to use project and applicant information for marketing, donor relations, communications, accounting, and tax reporting.

I agree to: *

Provide follow-up reporting satisfactory to DCCF regarding project completion and impact, and will make every reasonable effort to provide documentation requested by DCCF and/or its agents within a reasonable timeframe not to exceed 90 days following receipt of the request.

Questions about this form may be sent to [email protected].