Community Development Proposal Partner Supplement
If your project will be carried out in more than one physical location, complete the Multi-Site
Breakdown included in the budget pages detailing line item budgets for each activity and
location. Complete this Partner Supplement for each Partner or Consultant that will be
providing direct services as a part of this project and is projected to receive $5,000 or more in
funding. Job Descriptions must be attached for all DCHD funded staff. If the project is funded,
all contractual requirements and obligations of the fiscal manager will be passed on to the
Partners.
Agency Name
Agency Address
Director's Name
Project Name & Address
Contact's Name & Phone
E-Mail Address E-Mail Address
How many overall project
clients will you serve?
How many overall units of
service will you provide?
How many DCHD clients
will you serve?
How many DCHD units of
service will you provide?
Project Summary:
Briefly describe your role in the provision of services for the project.
Budget:
COST COMPONENT DCHD
FUNDING
REQUEST
OTHER
CASH
RESOURCES
IN-KIND TOTAL PROJECT
COST (no In Kind)
Total
I certify that I am authorized to sign legal documents on behalf of this organization.
I certify that the information contained in this funding application is true and correct.
Signature and Printed Name
click to sign
signature
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