Grant Application NHEC Foundation Grant Application Contact InformationName of Organization*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person* First Last Email Address* Phone Number*Project/Program DescriptionProject/Program Title*Amount of funds requested*In 1-2 sentences, please give a brief description of what the funding will support:*Geographic area(s) to be served by Project/Event/Program:*Application Supporting Questions* Drop files here or Select files Accepted file types: jpg, jpeg, pdf, doc, docx, xls, xlsx, xlsm, xlsb, Max. file size: 1 GB. The Application Supporting Questions consists of 8 questions that provide an overview of your organization and request. You can find this form online at https://www.nhec.com/nhec-foundationCurrent Financial Statements (Tax 990 filings are required. If you cannot provide your most recent tax filing, please contact Sara Thielbar, thielbars@nhec.com)* Drop files here or Select files Accepted file types: jpg, jpeg, pdf, doc, docx, pdf, xls, xlsx, xlsm, xlsb, Max. file size: 1 GB. Audited if availableProject/Program Budget* Drop files here or Select files Accepted file types: jpg, jpeg, pdf, doc, docx, pdf, xls, xlsx, xlsm, xlsb, Max. file size: 1 GB. Board of Director Listing* Drop files here or Select files Accepted file types: jpg, jpeg, pdf, doc, docx, pdf, xls, xlsx, xlsm, xlsb, Max. file size: 1 GB. IRS 501 (c)(3)* Drop files here or Select files Accepted file types: jpg, jpeg, pdf, doc, docx, pdf, xls, xlsx, xlsm, xlsb, Max. file size: 1 GB. Other Documentation Drop files here or Select files Accepted file types: jpg, jpeg, pdf, doc, docx, pdf, xls, xlsx, xlsm, xlsb, Max. file size: 1 GB. Digital SignatureName* First Last Today's Date* MM slash DD slash YYYY CAPTCHA Δ