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External Entity Funding Request Form


  1. Orange County Finance Department
    112 W. Main Street
    Orange, VA 22960

  2. Orange County, VA External Entity Request Form

  3. Due Date

    Forms are due December 31, 2019 for funding starting July 1, 2020.

  4. Has Orange County funded this agency previously?*

  5. Please Attach the Following Documentation

  6. Complete the following for each program serving Orange County citizens and for which funding is requested. Any incomplete applications or programs that do not have a full application will not be considered for funding. Please do not include any unrequested information. Orange County reserves the right to request additional information once the application has been submitted.

  7. Program 1

  8. Is this a new program?

  9. (The description should not exceed 10 lines of text)

  10. (Please state clearly why this service should be provided to the citizens of Orange County and why the Board of Supervisors should consider this funding request. If this is a new program, be sure to include the benefit to the County for funding a new request. The justification should not exceed 10 lines of text, and should inculde the most recent data available)

  11. (The information listed above should describe the specific population targeted by the program and shold not exceed 5 lines of text)

  12. (Please describe the program's intended geographic service area. This may include entire regions, localities, or specific schools, neighborhoods, etc.)

  13. (Please state the geographic location of the service, the duration and frequency offered to the clients. If service area includes other municipalities please indicate what amount of funding ($ or %) is received from that locality)

  14. (Please describe the fees clients must pay for the services provided in this program, and how those fees are determined)

  15. Program 2

  16. Is this a new program?

  17. (The description should not exceed 10 lines of text)

  18. (Please state clearly why this service should be provided to the citizens of Orange County and why the Board of Supervisors should consider this funding request. If this is a new program, be sure to include the benefit to the County for funding a new request. The justification should not exceed 10 lines of text, and should inculde the most recent data available)

  19. (The information listed above should describe the specific population targeted by the program and shold not exceed 5 lines of text)

  20. (Please describe the program's intended geographic service area. This may include entire regions, localities, or specific schools, neighborhoods, etc.)

  21. (Please state the geographic location of the service, the duration and frequency offered to the clients. If service area includes other municipalities please indicate what amount of funding ($ or %) is received from that locality)

  22. (Please describe the fees clients must pay for the services provided in this program, and how those fees are determined)

  23. Program 3

  24. Is this a new program?

  25. (The description should not exceed 10 lines of text)

  26. (Please state clearly why this service should be provided to the citizens of Orange County and why the Board of Supervisors should consider this funding request. If this is a new program, be sure to include the benefit to the County for funding a new request. The justification should not exceed 10 lines of text, and should inculde the most recent data available)

  27. (The information listed above should describe the specific population targeted by the program and shold not exceed 5 lines of text)

  28. (Please describe the program's intended geographic service area. This may include entire regions, localities, or specific schools, neighborhoods, etc.)

  29. (Please state the geographic location of the service, the duration and frequency offered to the clients. If service area includes other municipalities please indicate what amount of funding ($ or %) is received from that locality)

  30. (Please describe the fees clients must pay for the services provided in this program, and how those fees are determined)

  31. Program 4

  32. Is this a new program?

  33. (The description should not exceed 10 lines of text)

  34. (Please state clearly why this service should be provided to the citizens of Orange County and why the Board of Supervisors should consider this funding request. If this is a new program, be sure to include the benefit to the County for funding a new request. The justification should not exceed 10 lines of text, and should inculde the most recent data available)

  35. (The information listed above should describe the specific population targeted by the program and shold not exceed 5 lines of text)

  36. (Please describe the program's intended geographic service area. This may include entire regions, localities, or specific schools, neighborhoods, etc.)

  37. (Please state the geographic location of the service, the duration and frequency offered to the clients. If service area includes other municipalities please indicate what amount of funding ($ or %) is received from that locality)

  38. (Please describe the fees clients must pay for the services provided in this program, and how those fees are determined)

  39. Program 5

  40. Is this a new program?

  41. (The description should not exceed 10 lines of text)

  42. (Please state clearly why this service should be provided to the citizens of Orange County and why the Board of Supervisors should consider this funding request. If this is a new program, be sure to include the benefit to the County for funding a new request. The justification should not exceed 10 lines of text, and should inculde the most recent data available)

  43. (The information listed above should describe the specific population targeted by the program and shold not exceed 5 lines of text)

  44. (Please describe the program's intended geographic service area. This may include entire regions, localities, or specific schools, neighborhoods, etc.)

  45. (Please state the geographic location of the service, the duration and frequency offered to the clients. If service area includes other municipalities please indicate what amount of funding ($ or %) is received from that locality)

  46. (Please describe the fees clients must pay for the services provided in this program, and how those fees are determined)

  47. Leave This Blank:

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