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Funding Guidelines for Agencies
Agency Application For Funding Checklist
Agency Application For Funding
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Home
About CCBDD
About CCBDD
Meet our Board
Meeting Schedule
Meeting Agendas & Minutes
CCBDD By-Laws
Application Information
Funding Guidelines for Agencies
Agency Application For Funding Checklist
Agency Application For Funding
Contact Us
Contact Us
Agency Application For Funding
Serving Cape County Since 1975
Apply Today
Agency Application For Funding
Download the PDF Form
"
*
" indicates required fields
Step
1
of
11
9%
Legal Name of Requesting Agency:
*
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Website
*
Board Chair
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Agency Director
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Total Amount of Funds Requested from CCBDD:
*
Funding Period (Start)
*
Funding Period (End)
*
General purpose for which funds are requested:
*
Establish a new program or service
Expand an existing program or service
Maintain an existing program or service
Other
Present annual budget of requesting agency:
*
Cash reserves on hand:
*
Amount necessary to maintain six (6) month reserve:
*
*Based on total expenses from most recent fiscal year including capital expenses but not depreciation. Attach separate page if necessary.
History and background of requesting agency is required of all agencies not previously funded. Attach narrative description of agency's mission, past and present programs, individuals served, statistical/anecdotal evidence of success, etc., if not already submitted for prior funding.
Upload
Accepted file types: doc, docx, rtf, txt, Max. file size: 256 MB.
Previously funded within the last five calendar years?
*
Yes
No
List grants previously funded and date by CCBDD:
*
Describe the need or problem to be addressed by proposed project, and the anticipated goals and outcomes. Include applicable statistics and examples. Attach separate page if necessary.
*
Information regarding individuals to be served:
1) Number of persons with developmental disabilities from Cape Girardeau County presently served in existing program (if applicable)
2) Number of additional persons with developmental disabilities from Cape Girardeau County to be served in new or expanded program
3) Prospective ages of persons with developmental disabilities from Cape Girardeau County to be served by this existing/new/expanded program
0-4
5-15
16-20
21-55
56-Older
Please list all anticipated sources of funding for this project and the amounts requested from each source.
*
Add additional fields as needed.
Source of funding
Amount of funding requested
Prospective or committed?
Add
Remove
Total projected funding
*
I affirm that I have reviewed this report and to the best of my knowledge, the information furnished is true, correct and complete. My signature below authorizes this application for funding through the Cape Girardeau County Senate Bill 40 Board.
Signature of Board Chair
*
Signature of Agency Director
*
Date
MM slash DD slash YYYY
Date
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.
Agency Application Checklist
Funding Guidelines for Agencies
Agency Application for Funding
Get in Touch
Anytime
director@capecountyboard.org