HSC Youth Grant Application

Hemlock Semiconductor Youth Grant Program Application
Date

MonthDayYear
Date
HSC Employee Name*

First NameLast Name
HSC Employee E-mail*
example@example.com
HSC Employee Phone *
Please enter a valid phone number.
How are you connected to / what is your role within Hemlock Semiconductor?*
Which of the following description best fits your volunteer plans?*

$500 - I wish to sponsor a youth group of at least 8 youth who will dedicate a minimum of 3 hours each to volunteering with a registered 501(c)3 charitable organization or school WITHOUT MY PERSONAL PARTICIPATION$1,000 - I WILL VOLUNTEER WITH a youth group of at least 8 youth for a registered 501(c)3 charitable organization or school. The youth and I will all volunteer for a minimum of 3 hours each.$500 - I WILL PERSONALLY VOLUNTEER individually or with other HSC Employees a combined minimum of 24 hours to a registered youth-focused registered 501(c)3 charitable organization or school. I will act as a coach or mentor or will provide other services to the youth organization. PLEASE NOTE; hours dedicated to fundraising or securing sponsorships are NOT eligible for this grant opportunity

Name of the Fiduciary Organization for the Youth Group (the "parent organization" of the individual youth group you're with which you're volunteering or sponsoring)
This should be the formal name of the Organization to which funds will be sent and which holds the Tax ID number you are using (i.e., Midland Public Schools is the fiduciary for the Dow High Varsity Softball team).
In which county does the benefitting youth organization operate?*
** You should hear from someone from selected community foundation within two weeks of submission of this application. If not, please reach out to that foundation.
Fiduciary Organization Tax Id Number*
Fiduciary Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Youth Group or Team Name, if applicable
Here's where you specify the youth group within the Fiduciary Organization, for example, "Freeland High School Drama Club"
PLEASE NOTE - part of the program requirements are three high quality images of the young people either volunteering or benefitting from your volunteer hours. Please ensure that the youth organization has the necessary signed media releases or verbal permissions from the parents / guardians of all individual youth participating in the youth organization to be photographed or recorded.
Youth Group Primary Contact Name (if this is not you)

First NameLast Name
Youth Group Contact E-mail (if this is not you)
example@example.com
Youth Group Contact Phone Number (if this is not you)
Please enter a valid phone number.
Please describe the Youth Group or Youth-Serving Fiduciary Organization*
What is their mission? Why do they do what they do?
Statement of the Youth Group's Needs to be addressed with HSC Youth Grant funds*
For what will the grant funds be used? What factors contribute to the need? Why is it important to the group?
Proposed Charitable Organization to benefit from youth volunteer hours
At which registered 501(C)3 charitable organization will the Youth Group volunteer? Skip if you are serving the minimum 24 hours yourself or with other HSC Employees as the benefiting charitable organization is the youth group's parent organization
Physical location of proposed Volunteer Activity
If different from the Fiduciary address provided above
Proposed Volunteer Activity Description*
* If you are sponsoring or volunteering along with the Youth Group, this should be planned and coordinated with both the Youth Group AND the registered 501(c)3 charitable Organization Contact before your submission. If you are serving the minimum 24 hours of volunteer time yourself or with other HSC Employees, what will you be doing for the youth-focused registered 501(c)3 Charitable Organization? What role will you serve to benefit said charitable organization?
Proposed Number of K-12 Youth volunteering
Estimated number of Youth volunteer hours
Estimated number of HSC Employees participating*
(Adult participation is not included in Evaluation process)
Estimated number of HSC Employee volunteer hours*
You should hear from a representative of your selected county's community foundation within two weeks of your submission. If you do not hear from anyone within that window, please contact the representative listed in the email you will receive upon submission.
Should be Empty:

Hemlock Semiconductor Youth Grant Program Application

You should hear from a representative of your selected county's community foundation within two weeks of your submission. If you do not hear from anyone within that window, please contact the representative listed in the email you will receive upon submission.