APPLICATION

Grants for 2025 funding will be due January 31st, 2025. If you have any questions about the application or the process, please don’t hesitate to reach out to Hattie at director@rchealthfoundation.org

Once you have submitted your application, you may be asked for financial information for your organization.

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Name of Organization

Address

Address 1

Address 2

City

State

Zip Code

Program Director

Phone

(###) ###-####

Website

If you do not have a website, please put N/A in the box.

Names of Board of Directors/ Church Board

If you would like to send you list as an attachment, please send to director@rchealthfoundation.org

Date organization was established

Please upload a copy of your organization's IRS determination letter

Click or drag a file to this area to upload.

Organization's Mission Statement

Project Title

Amount Requested

Concise Statement of Grant Request

Please state how the grant will be used if awarded. If more space is needed, please email attachments to director@rchealthfoundation.org

Description of how the project will be evaluated

Please include qualitative and quantitative measures.

What is your proposed budget for the project?

Send quotes received or any other financial information that pertains to your project.

As a foundation focused on health, we would like to better understand how your project fits into the current Community Health Needs Assessment for the Rockbridge Area.

Please explain any connection your project has with the current Community Health Needs Assessment (found at https://www.carilionclinic.org/community-health-assessments#rockbridge-area)

List coalitions you are a member of or collaborations with other organizations in the community.

We are looking to support organizations that are willing to work with other organizations to ensure the grant funds help as many people as possible in Rockbridge County.

Other Financial Resources to which you have applied for the above purposes, or which you plan to develop.

Please also state what steps you have taken to raise money for this program.

We would like to know about the future of your program. Please tell us your plans for this program if funding is not received or if future funding is not available after one year.

Name of person applying

Signature

Please type your name to sign your application.

Position within Organization