Community Development Fund-County Exec’s Contingency Fund

Requests are reviewed once a month. If your submission is received after requests have been reviewed, it will be included in the submissions for the following month. Please note, a decision regarding your request could take up to 60 days.

** Contact Stephanie Mohr with application questions: 302-395-5117 or by email at stephanie.mohr@newcastlede.gov

Are you a registered vendor in Munis (NCC financial system )? Value is not selected

FEIN Number (Format: ##-#######)

-- ATTENTION --

Your Community Development Fund application cannot be completed because you are not a registered vendor in the New Castle County financial system - Munis. Click link Vendor Self Service to complete registration. Please note: all vendors must complete and upload a signed W9 for registration to be considered complete. You have thirty (30) days to complete the registration process. If not completed within this time frame, your application will be invalid.

Name of Organization

Organization 501c3

Yes

No

What Type Of Request?

Event Sponsorship Request

Grant Request

What Is The Date Of The Event?

Organization’s Point of Contact First Name

Organization’s Point of Contact Last Name

Organization’s Point of Contact Phone Number

Organization’s Point of Contact Email Address

Amount Requested

Intended Use of Funds:

Projected number of people this requested grant will serve:

Fiscal dates of your organization:

List previous NCC grants (dates and usage) If Applicable, list dates and usage here:

Other funding sources for this request: If Applicable enter funding sources here:

Organization’s Mission Statement:

Are there any New Castle County employees associated with your organization?

Yes

No

Does your organization have a non-discrimination policy?

Yes

No

If yes, please give the name of the policy in use.

If no, please explain why not?

Upload your organizations most recent w9 tax form

I certify that all the above information I provided on and in connection with this form is true and correct to the best of my knowledge. I also understand that any false statements or deliberate omissions on this form may subject me to disqualification for consideration of future funding.

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Community Development Fund