Apply

Copies of the grant application may be downloaded in PDF format or may be obtained by contacting the Foundation at 931-502-1131. This application form will include a copy of the contract (to be completed if the grant is approved), and a copy of the follow up form (to be filed after the grant project has been completed).

The completed grant application should be mailed to Clarksville-Montgomery County Community Health Foundation, Inc. at P.O. Box 31003, Clarksville, TN, 37040. The grant application will then be distributed to the committee members who are responsible for evaluating the requests. The grants will be evaluated quarterly in the order in which they are received. A member of the evaluation committee will contact the applicant if any questions arise during the evaluation process.

CMCCHF Application Specific Project>> download
Contract Requesting Organization>> download
Grant Follow-up Report>> download
CMCCHF Principles>> download

Name of Requesting Organization

Date of last IRS determination

Designation by IRS

Select One:
I will mail documentation. I will fax documentation.

Contact Person

Contact Phone Number

Contact Email

Brief description of project for which funding is requested: An Overview.

State the goals and objectives:

State the time table for accomplishing the goals and objectives:

Describe the evaluation process you will use to evaluate how you have met your goals and objectives:

Describe how the project relates to the requesting organization's long-term plans and  priorities:

Describe the present and future impact this project will have on the health of the community:

Provide an itemized budget for the project for which monies are requested.

List other sources of funding commitments received to date with amounts listed:

Describe how the request will impact the organization's future operating budget (expenses and revenues). What is your organizations financial plan for future sustainability of this project after this grant is spent?

 Meetings and site visits will be scheduled with applicant organization by CMCCHF, Inc. if deemed appropriate after your grant request is studied by the evaluation committee.

I understand that if this grant is approved that we will sign a contract currently furnished to me which binds us to the details in this application.