HUMAN SERVICES ADVISORY COUNCIL, INC
P.O. Box 894 Council Bluffs, Iowa 51502
Email address *
HSAC COMMUNITY FUNDING APPLICATION
*Funding is limited and will be awarded on a first come first serve basis.

Requirements: Applicants must be an HSAC member in good standing, a 501c3 (include a copy with the application). Funds are awarded through a reimbursement process that will occur in a timely manner once receipts are received. A receipt for sponsorship is also required. Marketing materials must include the HSAC logo which will be provided by the Finance Committee
Member Organization *
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Contact Person *
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Phone # *
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Email Address *
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1. What HSAC Committee is requesting the funds? *
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2. Outreach Title *
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3. Brief Description (Include need, goal(s), impact [#people affected], activities, and any collaboration [include names of organizations/businesses]) *
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4. Outreach start date *
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5. Outreach end date *
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5. Cost of total project ($) *
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6. Amount requested from HSAC ($) *
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Date *
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