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Social Service Funding Application

  1. Funding Criteria

    1. Must be an incorporated agency, with proof of not-for-profit status for one year minimum and not another taxing body (per Board Policy).

    2. Services provided should be of a type that a Township might otherwise provide directly or indirectly to its residents.

    3. Frequency of Township referrals and agency response to those referrals.

    4. Services provided must be available to all Vernon Township residents.

    5. Town Board members, at their discretion, may visit individual sites.

    6. A Service Agreement Contract will be provided to you after approval of your grant. This must be returned and signed by a signatory representative of your organization. Please note the request of proof of insurance with Vernon Township as additionally insured.

    Applications MUST be received by December 28th to be considered.

  2. What percent of your operation is funded by:

  3. Specify below.

  4. Are programs, services, activities, and facilities provided by your agency available to residents of Vernon Township?

  5. Is your operation age or gender specific?

  6. Do you charge for your services?

  7. If yes, do you charge on a sliding scale?

  8. Do you use volunteers in your program?

  9. Examples: new personnel, programs, goals, facilities.

  10. Please submit a copy of your organization's last fiscal year certified audit. Submit documentation showing status of non-for-profit.

  11. Leave This Blank:

  12. This field is not part of the form submission.