General Grants Application | Worth County Development Authority

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Worth County Development Authority
91 8th St N
Northwood, IA 50459

Be sure to include ALL supporting information with your application, including photos, vendor estimates, financial statements, and exemption letters.

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WORTH COUNTY DEVEOPMENT AUTHORITY
GRANT APPLICATION FORM A
Effective 5/13/2013
New grant deadlines are as follows:
Spring grant application will be accepted January 1 - February 1 by 4:00
Fall grant applications will be accepted August 1 - September 1 by 4:00
Project Title
Amount Applied For

1) Name of Applicant
2) Contact Name
3a) Physical Address
3b) P.O. Box
4a) City
4b) State
4c) Zip
5) County and Township of Project
6) Telephone
7) IRS Exempt Status
Our organization has been approved by the IRS as a 501(c)(3) tax-exempt entity.We have, and are attaching, a current IRS 501(c)(3) designation letter.

8) Give a brief description of the project and what the money will be used for
9) How many times have you applied to WCDA for this particular project?
10) State source of additional funds and amounts from each source. Note: if outside Worth County, you MUST have 25% matching funds.
*NOTE: If entities outside of Worth County do not have at least 25% matching funds, AT TIME OF GRANT REQUEST, the application will be pulled.
11) How does this project enhance the quality of life in Worth County and/or North Central Iowa?
12) Does this project enhance economic growth? How?
13) Applications over $10,000 must have 2 bids. Attach chosen bid. Supply the name and amount of second bid. If lowest bid not used, please explain why.
14) If this request can be broken down into parts, please prioritize those parts as separate items and state the dollar amount required for each.
15) Attach a photo or line drawing of project when available.
16) Attach detailed estimates from lowest bid.
17) Attach a copy of your most recent financial statement.
18) Attach IRS exemption Letter.
*NOTE: APPLICATIONS WILL BE WITHDRAWN IF ITEMS 13, 16, 17 AND 18 ARE NOT INCLUDED.
ALL APPLICATIONS MUST BE IN OUR OFFICE BY 4 P.M. ON DATES DUE.
NO PROJECTS ARE TO BE STARTED UNTIL GRANT AWARDS ARE ANNOUNCED. IF PROJECTS ARE STARTED BEFOREHAND, APPLICATIONS ARE NULL AND VOID.
WE CERTIFY THE ABOVE INFORMATION TO BE TRUE TO THE BEST OF OUR KNOWLEDGE AND APPLY FOR THIS GRANT IN GOOD FAITH
NAME
TITLE
Date
All grants need to be returned to the Worth County Development Authority Office located at: 91 8th St N, Northwood, Iowa 50459. Please call the office at 641-324-1618 if you have any questions regarding the guidelines or application.
For WCDA Office use only
TRUSTEE RECOMMENDATION
AMOUNT
Signature
(REVISED 4/5/13)

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