Community Cares Grant Application

Applicant Name/Organization

Phone

Address

City/Town

State

Zipcode

Is the organization exempt from payment of income tax?

Yes

If yes, a copy of an IRS letter indicating your organization's 501c3 may be asked for to verify.

If this individual or organization has previously received a Riverland Community Cares grant, provide the following information about the most recent grant received:

Date

Amount

What communities/counties are served by your organization?

Describe the specific project or purpose for which the funds will be used. Attach separate sheet if necessary.

Other revenue resources: