Healthy Homes Grant Application

Healthy Homes Grant Application
Please read through the program guidelines, application, required documents, and project assurances before you begin. Program information is available at www.emmetsburg.com/healthyhomes.

Projects must be pre-approved to be eligible for grant funding.

Owner/Applicant Information
Property Owner(s)
Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

Proposed Exterior Improvements
Please describe the physical improvements you would like to complete as part of the program and how the proposed improvements will impact the property and neighborhood.
Are there any improvements you plan to make to your property outside of Healthy Homes grant funding?
Please describe your plan to maintain the property after improvements are made.

Project Budget

Please provide estimates for each component of the proposed project (i.e. windows, doors, paint, roof, insulation, etc.).

Rows	Proposed Improvement	Vendor/Contractor	Anticipated Cost
Expense 1
Expense 2
Expense 3
Expense 4
Expense 5
Expense 6
Expense 7
Expense 8
Expense 9
Expense 10

Please attach vendor estimates.

Vendor estimates are REQUIRED
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Grant Request
Based on your estimate of the cost of work, please state the matching amount you are requesting from the Healthy Homes Grant Program (maximum $500). This should be no more than 50% of the total project costs.
Please indicate which funding cycle you are applying for.

Agreement & Signature
Assurances
Signature
Should be Empty: