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Community Health Contract Grant Application
FY 2026.2027
START
Language
English (US)
Spanish (Latin America)
1
Provide your 501c3 tax designation identification number.
*
This field is required.
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2
Service Area
*
This field is required.
What area(s) does your organization serve (check all that apply).
Bonsall
De Luz
Fallbrook
Rainbow
None of these areas - not eligible for consideration
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3
Organization Name
*
This field is required.
Provide the legal name of the organization, as it appears on your 990. If you have a different DBA or nickname, please add that in the box adjacent to the legal name. State NA if the DBA is not applicable.
Legal Name
DBA (if Applicable)
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4
Contact Information: Submission
*
This field is required.
Please add the contact information for the person responsible for the submission and administration of this grant proposal.
Contact Name
Title
Primary Contact Phone
Email Address
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5
Is the Organization's mailing address the same as the service address?
*
This field is required.
YES
NO
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6
Organization Mailing Address
*
This field is required.
This is the address documents and payments will be mailed.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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7
Organization Physical Address
*
This field is required.
This is the primary address where the Organization provides services.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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8
Date Founded/Services Offered in Fallbrook area
*
This field is required.
Provide the legal date your organization was founded, and when did your organization begin offering services in the Greater Fallbrook area?
Date Founded
Date services in Fallbrook area began
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9
Organization’s Mission Statement
*
This field is required.
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10
Organization’s Vision Statement
*
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11
Statement of Need
*
This field is required.
Be sure your file meets our submission requirements as listed on our website, please limit this section to two pages. Discuss the need for your organization’s activities within the service area of the Fallbrook Regional Health District (FRHD). The Statement of Need must clearly relate to your organization's mission and purpose. It should focus on the people you serve, not organizational needs, and it should be well supported by evidence and trends within your service sector. Identify which social determinants of health are addressed within this need. Include qualitative and quantitative data that support your argument, as well as relevant statistics and research, to demonstrate why this is a need within the District. Using the Social Determinants of Health as the model, provide examples of how your organization’s activities support disease prevention or the promotion of healthy lifestyle behaviors. Briefly describe how your organization aligns with FRHD’s strategic priorities of: Diabetes prevention or management, cardiovascular disease management – i.e., hypertension, obesity, mental health, and basic needs and healthcare access.
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12
Outcomes & Impact
*
This field is required.
Be sure your file meets our submission requirements as listed on our website, please limit this section to one page. Discuss how the organization's activities are measured for impact. Provide details on the short and or long-term impact of these activities from within the context of the social determinants of health. Include both qualitative and quantitative data that reflect your organization's impact. Be sure to include how this impacts FRHD’s strategic priorities of: Diabetes prevention or management, cardiovascular disease management – i.e., hypertension, obesity, mental health, basic needs and healthcare access.
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13
Organization Collaborations
*
This field is required.
Active collaboration is demonstrated by specific ongoing actions that benefit two or more organizations. Explain how this collaboration provides support for your organization. These collaborations may be already established or initiated within the grant cycle. Applications with established or planned collaborations will receive greater consideration. Do not list funders or other financial supporters who are not directly involved in the provision of the service/program.
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14
How are other organizations addressing these needs in the community?
*
This field is required.
What other organizations within the community offer similar programs/services that address the needs outlined in your Statement of Need section? Explain why your organization's provision of services is different from/or compliments
offerings from other providers.
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15
Funding Amount Being Requested
*
This field is required.
We encourage you to request an amount that reasonably reflects your organization's size, budget, and community impact. With a limited grantmaking budget and a commitment to support as many qualified applicants as possible we ask that you thoughtfully consider your organization's needs and overall context when determining your request. Final grant award amounts may differ from the requested figure.
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16
Organization Budget
*
This field is required.
Upload your organization's budget. You may include a single page budget narrative to help explain unique aspects of your operations.
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17
Additional Funding Support
*
This field is required.
Upload a list of funding partners for the last two years. Grants should be listed by funding entity name, amount awarded and date. Include a separate line that reports the total, by year, for organizational funding support from events and general donations. Donor names do not need to be disclosed.
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18
Projected number of residents that directly benefit (participant/client) from your organization's services and programs in FY26.27 - July to June.
*
This field is required.
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19
Target Population: Age
*
This field is required.
List the percentages of your program participants’ ages. Percentages must add up to 100%
Percent of program participants
Estimated number of participants
Children (infants to 12)
Row 0, Column 0
Row 0, Column 1
Young Adults (13-17)
Row 1, Column 0
Row 1, Column 1
Adults (18-60)
Row 2, Column 0
Row 2, Column 1
Seniors (60+)
Row 3, Column 0
Row 3, Column 1
We do not collect this data (indicate with 100%)*
Row 4, Column 0
Row 4, Column 1
Children (infants to 12)
Young Adults (13-17)
Adults (18-60)
Seniors (60+)
We do not collect this data (indicate with 100%)*
Percent of program participants
Row 0, Column 0
Estimated number of participants
Row 0, Column 1
Percent of program participants
Row 1, Column 0
Estimated number of participants
Row 1, Column 1
Percent of program participants
Row 2, Column 0
Estimated number of participants
Row 2, Column 1
Percent of program participants
Row 3, Column 0
Estimated number of participants
Row 3, Column 1
Percent of program participants
Row 4, Column 0
Estimated number of participants
Row 4, Column 1
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20
Target Population not collected: Age
*
This field is required.
If you indicated that you do not collect data on the above question, please provide a rationale as to why that information is not sought. Write N/A if this question does not apply to your organization.
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21
Target Population: Gender
*
This field is required.
List the percentages of your program participants’ gender identification. Percentages must add up to 100%.
Percent of program participants
Female
Row 0, Column 0
Male
Row 1, Column 0
Non-binary/Other
Row 2, Column 0
Unknown*
Row 3, Column 0
Female
Male
Non-binary/Other
Unknown*
Percent of program participants
Row 0, Column 0
Percent of program participants
Row 1, Column 0
Percent of program participants
Row 2, Column 0
Percent of program participants
Row 3, Column 0
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22
*Target Population: Gender
*
This field is required.
If you indicated that you do not collect data on the above question, please provide a rationale as to why that information is not sought. Write N/A if this question does not apply to your organization.
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23
Target Population: Income Level
*
This field is required.
List the percentages of your program participants' income limit category - 2025 HUD – AMI Income limits (4 person family). Percentages must add up to 100% for review of these limits visit:
https://www.sandiegocounty.gov/content/sdc/sdhcd/rental-assistance/income-limits-ami.html
Percent of program participants
Extremely Low-Income Limits, ceiling of $49,600
Row 0, Column 0
Very Low (50%) Income Limits, ceiling of $82,700
Row 1, Column 0
Low (80%) Income Limits, ceiling of $132,400
Row 2, Column 0
Higher Than Listed Limits
Row 3, Column 0
We do not collect this data (indicate with 100%)*
Row 4, Column 0
Extremely Low-Income Limits, ceiling of $49,600
Very Low (50%) Income Limits, ceiling of $82,700
Low (80%) Income Limits, ceiling of $132,400
Higher Than Listed Limits
We do not collect this data (indicate with 100%)*
Percent of program participants
Row 0, Column 0
Percent of program participants
Row 1, Column 0
Percent of program participants
Row 2, Column 0
Percent of program participants
Row 3, Column 0
Percent of program participants
Row 4, Column 0
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24
*Target Population - Income Level
*
This field is required.
If you indicated that you do not collect data on the above question, please provide a rationale as to why that information is not sought. Write N/A if this question does not apply to your organization.
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25
In what language(s) does your organization provide services?
*
This field is required.
Where most or at least half of the program can be provided in the participant's primary language.
English
Spanish
Tagalog
Chinese (Mandarin/Cantonese)
Other
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26
What demographic group does your organization program predominately serve?
*
This field is required.
Select the one category that best describes your program's participants.
Youth - school based
Older Adults
Youth - other setting
Special Populations
Community - Health & Fitness
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27
Anticipated Acknowledgment
*
This field is required.
Please select the methods by which the Organization will acknowledge the District's investment of funding.
Social Media Postings
Signage at Service Sites
Print Materials to Service Recipients
Website Display
Other
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28
Anticipated Acknowledgment
*
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Please explain how the District's name or logo will be promoted. If social media is selected, please identify which platforms your organization utilizes.
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29
Hours of Operation
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Provide the days and times when site visits can be made to the organization. Note that the site visit should be able to observe service activities when possible.
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30
Dates/Times of Organization Board of Directors Meetings
*
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Provide the days and times when your organization's Board of Directors meet. If these meetings do not occur on a regular basis, please explain how these meetings are arranged.
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31
Board of Directors
*
This field is required.
Upload a list of your Board of Directors: including Full Name - First, Last, Board Position, Professional Affiliation/Industry and contact email address.
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Max. file size
: 10.6MB
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32
Financial Documents: Audit
*
This field is required.
Most recent audited financials with management letter. If your agency does not have audited financials, please contact the District. *Please note that audited financials will be required for any agency older than 5 years or with an annual budget over $500,000.
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33
Financial Documents: P&L/Income Statement and Balance Sheet
*
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From the most recent fiscal year end
.
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34
Financial Documents: 990
*
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Most recent fiscal year end.
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35
Terms and Conditions
*
This field is required.
Checking this box certifies that all information presented in, or attached to, this application is complete and accurate, and that the organization is aware and will comply with the District's grant policies as posted.
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DRAFT FY 2026.2027 Fallbrook Regional Health District Community Health Contract Grant Application
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