FY 23-24 Simplified Grant Application - Grossmont Healthcare District

2023-2024 Simplified Grant Application

The following section contains instructions for completing a SIMPLIFIED grant application. A simplified grant application procedure is available to organizations seeking grants of $25,000 or less. If you are requesting more than $25,000, please complete a FULL grant application.

"*" indicates required fields

Contact Info

Legal Name of Organization*

Address*

Street Address Address Line 2 City State ZIP Code

Organization Website*

Organization Point of Contact*

First Last

Contact Email Address*

Proposed Project Title*

Amount of Funds Requested*

Anticipated number of GHD residents to be served*

Grant Application Summary

Attach a one page (500 words max) PDF including each of the following: description of proposed services, project site(s), target population(s), anticipated number of GHD residents to be served, community needs to be addressed, etc.*

Accepted file types: pdf, Max. file size: 50 MB.

Budget

Project Budget Form*

Accepted file types: pdf, Max. file size: 50 MB.

Download, fill out, and upload the form as a PDF using the link below.

Project Budget Form to be uploaded can be found HERE.

All Budget Sources Form

Accepted file types: pdf, Max. file size: 50 MB.

Download, fill out, and upload the form as a PDF using the link below.

All Budget Sources Form to be uploaded can be found HERE. (Required only of Simplified Grant applicants with an overall operating budget of $500,000 or more).

Digital Signature

Signature*

I (we) certify that all information included in this application is complete and accurate.

Digital Signature

First Last Title

By checking the “Signature” box above and including your full name and title, you are signing this form electronically. You agree that your electronic signature is the legal equivalent of your manual signature.