Merrimack County Social Services Grant Program Request for Proposal

Merrimack County Social Services Grant Program Request for Proposal

Applications Due July 31, 2023 4:00PM
Name of Organization Requesting Funding*
Name of Program/Project Requesting Funding*
Total Program Budget Request*
Not to exceed $100,000.00
Phone Number*
Please enter a valid phone number.
Organization's Fiscal Year (Ex. Jan 1-Dec 31 or July 1-June 30)*
UEI Number*
SAM Expiration*
Head of Agency*

First NameLast Name
Head of Agency Title*
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Project Director*

First NameLast Name
Project Director Email*
Project Director Phone Number*
Please enter a valid phone number.
Finance Director*

First NameLast Name
Finance Director Email*
Finance Director Phone*
Please enter a valid phone number.
Application Details

Please provide the following information.
Application Narrative - Please attach a document that includes the following: 1. Agency Overview, 2. Problem Statement, 3. Program Design/Implementation, 4. Financial Need Explanation, and 5. Sustainability Plan.*

Cancelof
Budget Worksheet
Budget Worksheet - Please provide a completed budget request from with narrative (provided above).*

Cancelof
Supporting Documentation

Please provide the following requested documents.
Agency Certification Form
Agency Certification Form - Please provide a signed Certification Form on agency letterhead (provided above).*

Cancelof
Certificate of Authority Form
Certificate of Authority Form - Please provide a signed Certificate of Authority form (provided above).*

Cancelof
Board of Directors - Please provide a current list of board members.*

Cancelof
Agency Budget - Please provide the full operating budget of the organization.*

Please provide the full operating budget.
Cancelof
Agency Audit (most recent) - If not available, attach non-audited financial statements with explanation of why audited statements are not available.*

Cancelof
Other supporting documentation - Please upload any other supporting documentation you would like to include in your application here.

Cancelof
Additional Information
Does your organization receive funds from other Merrimack County muncipalities?*

YesNo
If "Yes", list the other cities or towns providing funding and the amount of funding provided. If "No", enter N/A followed by zeros in the boxes. Click on the SAVE box to retain data.*
Does your organization provide services to Merrimack County residents?*

YesNo
If "Yes," please provide information in the table below on the total number of Merrimack County residents served. This information should be made available for each category of service or programs provided to Merrimack County residents. If "No", enter N/A followed by zeros in the boxes. Click on the SAVE box to retain data.*
Does Organization provide services to clients outside of Merrimack County?*

YesNo
If "Yes," please provide information in the table below on the number of clients receiving services from outside of Merrimack County. This information should be made available for each category of service or programs provided. If "No", enter N/A followed by zeros in the boxes. Click on the SAVE box to retain data.*
Are you requesting funding from Merrimack County due to a loss of funding from another source or projected reduction in anticipated funding from another source? If yes, explain this reduction or anticipated reduction in funds and the efforts that this will have directly upon your operations and services provided to Merrimack County.*
What would be the impact to Merrimack County residents if the services provided by your organization were not available?*
2023 Social Services ARPA Subrecipient Grant Application Budget
Thank you for your application for Merimack County ARPA Non-profit Subaward grant funding. Please ensure you have attached all required documents, as failure to do so may result in non-consideration. If you have any questions about the application or the selection process, please contact:

Jessica L. Riendeau, DCJ

Community Relations Coordinator

(603) 219-0627 x 2151

jriendeau@merrimackcounty.net
Should be Empty:

Merrimack County Social Services Grant Program Request for Proposal

Application Details

Supporting Documentation

Additional Information