Community Health Committee Funding Application

This form enables non-profit organizations to apply for funding through the Self Regional Community Health Committee.
  • Note: Email is required to apply online. If you do not use email, please contact Selynto Anderson, Community Prevention & Wellness Services Manager at 864-725-4164 or send application to Community Health Committee, 1325 Spring Street, Greenwood, SC 29646.
  • Accepted file types: pdf.
    Please upload a PDF document showing proof of your 501(c)(3) status.
  • Date Format: MM slash DD slash YYYY
    Note: The requested funding date must be at least 90 days from application date.
  • We require a completed W-9 in order to consider your application. If you do not already have a W-9 form, you may download one from the IRS website:
    https://www.irs.gov/pub/irs-pdf/fw9.pdf
  • Accepted file types: pdf.
    Please provide a W-9 for your organization so we can report the funding as required by IRS code.
  • Accepted file types: pdf.
    Please submit a cover letter for your project.
  • Accepted file types: pdf.
    Please provide a two-page proposal for your project including an outline and timeline for the project, description of partnerships and documentation, definition of outcomes measurement criteria, plus a simple project budget.
  • This field is for validation purposes and should be left unchanged.