Hernandez Palmerton Community Fund

Hernandez Palmerton Community Fund

Grant Application
The Rhett and Pat Hernandez Palmerton Community Fund is dedicated to supporting organizations and initiatives that make Palmerton a stronger, more vibrant community.

Guidelines:
- 501(c)(3) nonprofit organizations are encouraged to apply. If your organization is not a registered 501(c)(3), please contact us before submitting an application to see if you are eligible.
- The requested funds should support organizations and/or programming or projects that serve Palmerton and its residents.
- The project, program, or activities for which funding is sought should be completed within the 12-month period following the grant award. As part of the grant agreement, the organization should expect to provide a brief follow-up report at the end of the grant period.
Application Instructions:

Please complete the form below to submit your application. Applications should only be completed by someone who has permission to apply on behalf of the organization or project.

You may save your work and return to finish and submit the application later. A link to your saved application will be sent to the email address you enter in the first question, so please confirm there are no typos in that response. If the wrong email address is entered, your application draft will be lost and we will not be able to recover it for you.

Contact the Carbon County Community Foundation at director@cccfoundpa.org or 610-730-2526 if you have questions or want to discuss your application before submitting it.

Application are accepted year-round and reviewed quarterly.
Applicant Information

Please complete this section with your info in case we have follow up questions about your application.
Email Address
example@example.com
Name

First NameLast Name
Phone Number
Please enter the best number to reach you if we have questions about your application.Format: (000) 000-0000.
Organization Information
Organization Name
Organization Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Website
Organization Mission Statement

0/300
Is your organization affiliated with a regional or national organization or is it a standalone organization?
Is this a 501(c)3 nonprofit organization?
Organization EIN#
Current organization total operating budget
This is a single figure, the total revenue required to operate your organization annually. (25 character max)
Program/Project Info

The following questions pertain to the specific program/project for which you are requesting funding.
Title of Program/Project
One sentence summary of the purpose of program/project

0/200
Which funding/focus area best describes that addressed by your program/project? Select all that apply.
What is the total cost of the program/project?
What amount are you requesting from CCCF to support the program/project?
You may request up to the full amount needed to complete your project. The amount actually awarded will depend on your application as well as the other applications submitted and the total amount available to award. Please enter an actual dollar amount.
If we can only partially fund your request, will you be able to secure additional funds to go forward with the program/project within one year from award?
If we can only partially fund your request, what is the least amount you would need to move forward with the program/project in some capacity and still have an impact?
We recognize that this might mean less of an impact or number of people served. Please enter an actual dollar amount.
Program/Project Narratives

The following questions will allow you to provide more detail about the program/project for which you are requesting fund. As you are answering the questions, please keep in mind the Grant Application Evaluation Criteria (https://cccfoundpa.org/wp-content/uploads/2024/02/General-Guidelines-Evaluation-Criteria-for-Grants.pdf).
Please provide a detailed summary of the program/project for which you are requesting funding.

0/2500
Is this an existing or new program/project?
How will this project benefit the residents of Palmerton, PA?

0/1000
Community Partners

0/1000
Supporting Documents

Please upload the requested documents below.
Program/Project Budget

Please upload a budget for the program/project. Be sure to include all related expenses as well as any funds/support received or requested from other sources to support this specific program/project. PREFERRED FORMAT: PDF FILE
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IRS Determination Letter

Please upload a copy of the letter from the IRS verifying your 501c3 status. If you are not a 501c3, skip. PREFERRED FORMAT: PDF FILE
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Additional Documents

Please upload any other supporting document you wish to include with your application.
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Should be Empty:

Hernandez Palmerton Community Fund

Applicant Information

Organization Information

Program/Project Info

Program/Project Narratives

Supporting Documents