*All fields and check boxes must be completed or checked for this application to be accepted. All submitted applications will be time stamped, dated, and numbered in the order of reception.
About your City, Town or Community - (Population, Industry or Business, School, Parks, and or Community Buildings.)
Describe the purpose of your grant request and who it will serve:
Amount of funding requested from the CCCDC $
Describe the project for which the funds will be used:
What problems or needs will this project address:
How was the need determined:
Explain the specific goal of this project or program in meeting the problem or need:
What population group and how many people would be helped by this project:
What specific steps or plans are necessary to complete this project? (Include timetable):
Explain how this problem is being addressed by others in the community. How will you coordinate with them:
What efforts will be made to utilize existing human, physical or financial resources within the community or population in order to maximize the requested grant:
Describe the capacity to undertake the proposed project, including qualifications of staff involved along with an estimate of volunteer activities and number of hours to be allocated:
Who has given or pledged funds for this project? Where else are you seeking funds:
If this is an on-going project, how will it be financed or funded in the future:
Please list the name(s) of community leaders and organizations that endorse this project:
How will the project and the expenditure of requested funds (if granted) be monitored and the results evaluated:
OTHER: Briefly share other information you feel is relevant to the CCCDC consideration of this request:
Upload up to two (2) Photos that demonstrate the problem and location for which this grant will be considered.[500kb or less each, JPG/PNG]Note: If extra pictures are required, please mail to the address on the CCCDC webpage.
I understand that decisions regarding awarding of funds will be made at the discretion of the Cullman County Community Development Commission and I certify that I am an authorized agent to request this grant. I understand that any omissions or misstatements in this grant request may cause the rejection of this application. I further certify that upon the receipt of funds (if any) from the CCCDC I will within ninety (90) days thereof provide the CCCDC with a written certification that the funds have been used in the manner and for the purposes set forth above.
All grantees must abide by the State of Alabama bid law and are subject to follow up.
I agree that typing my name in the above box is the same as my physical signature on this form.