• Organization Name*
• Contact Name*
  
  First
  
  Last
• Contact Email*
  
• Phone*
• Address*
  
  Street Address
  
  Address Line 2
  
  City
  
  State / Province / Region
  
  ZIP / Postal Code
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  Country
• Tax ID Number (No Dashes)*
• Organization Website*
• Are you a 501(c)(3) organization or government agency? If no, you are not eligble to apply.*YesNo
• Are you located in Alamance County and do you serve Alamance County residents?*YesNo
• How long have you operated as a nonprofit in Alamance County?*Less than a year1-3 Years4-10 YearsMore than 10 Years
• Does your proposed project have a clear tie to measurably improving the community's:*Access to CareEducationEconomy
• Briefly describe in two paragraphs or less your proposed project and the need it will address. Include data to support this. What type of equipment are you asking to be funded?*
• How will the equipment you are asking to purchase enhance community health and benefit our community? Please remember funds are only for equipment with a useful life of 3 years or more.*
• What outcomes do you hope to achieve?*
• How many people will be served?*Please enter a number from 10 to 150000.
• If selected to apply, what amount of funding will you be requesting?*Please enter a number from 500 to 50000.
• Briefly describe the community you are serving. If possible, please provide the race and ethnicity of the residents you will serve.
• Upload a copy of your current Solicitation License.*Max. file size: 50 MB.
• Upload a copy of your IRS tax exempt letter.*Max. file size: 50 MB.

• Letters of Intent are due by 5PM, March 9, 2023. Please remember if you save your application, to save the email you will receive from Word Press so you can return to your application to complete it prior to submission.

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