2017 NCHS Capital Grants Letter of Intent
Organizational Name
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Contact Person
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Phone Number
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Email Address
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Which county do you represent?
Are you a 501(c)3 organization?
Does your organization own the facility to be improved or will you own the equipment to be acquired?
Does your request involve any ineligible projects, such as repair or replacement of outdated equipment, or maintenance such as roof and window replacement, furniture replacement, etc.?
Provide a brief summary of your proposal: this should identify the items you wish to purchase and the reason why the item or items are needed.
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