Community Health Committee Funding

Apply for funding to help us achieve a healthier community — together.

The Self Regional Community Health Committee meets quarterly to discuss funding proposals from nonprofit organizations within our 7 county service area. The goals of the committee are aligned with our Community Health Needs Assessment and include improving preventative health services, improving healthy outcomes, and focusing on the social determinants of health to improve health equity for all.

For more information, please call (864)725-4164.

Funding Request Timelines

Application Due Dates:
February 28 for March Funding
April 1st for May Funding
July 1st for August Funding
October 1st for November Funding

Community Health Funding Application

This form enables non-profit organizations to apply for Community Health project funding through the Self Regional Community Health Committee. Revised January 2022.

Organization Name(Required)

Funding Request Application Checklist

1. IRS Not-for-profit Approval Letter(Required)

Max. file size: 20 MB.

2. Most Recent Filed Tax Form 990 (if applicable)

Max. file size: 20 MB.

3. Business Plan or Budget(Required)

Max. file size: 20 MB.

4. Most recent Audit Report (if applicable)

Max. file size: 20 MB.

5. Most recent Financial Statements(Required)

Max. file size: 20 MB.

6. Proof of Professional Liability Insurance(Required)

Max. file size: 20 MB.

Funding Request Details

Submitter Name(Required)

First Last

Submitter Title(Required)

Submitter Email(Required)

Contact Phone(Required)

Project Title(Required)

Project Start Date(Required)

Funding Amount Requested(Required)

Project Goals and Outcomes(Required)

Goal Measurements:(Required)

Questionnaire

1. What is the Mission of your organization?(Required)

2. Describe how your organization aligns with the focus areas identified in the Community Health Needs Assessment, as outlined on the Self Regional Healthcare website.(Required)

3. What is your geographic area served and target population?(Required)

4. Please provide a list of your Board Members.(Required)

5. List all Funding or Grants awarded (with amounts) and other Grant applications submitted.(Required)

6a. Itemize how your funding request will be used (if not included in Business Plan).(Required)

6b. Describe the need for future funding requests.(Required)

7. What is the date your organization was established?(Required)

8. Number of Employees in Organization?(Required)