Application Form -PREVIEW

Washington State Dept. of Commerce
Commerce Community Capital Facilities
2017-19 Behavioral Health Facilities Grant Round Two

CLOSED Deadline 2/7/2019

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The program is open to nonprofits, public entities, for-profit businesses and tribes. Guidance is provided in the program's enabling legislation click here for the program legislation ( Section 1007) and in the program guidelines Click here for program guidelines The maximum amount of funds an applicant can receive is $2,000,000 per project, except for the Acute Detox category, which has a maximum grant amount request of $661,341.

This application closes at 5:00 p.m. sharp on 01/30/2019.

Applicant View

Application Status: Not Submitted

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Summary Application Questions Budget Documents Activity Log

Summary

(answers are saved automatically when you move to another field)

Instructions Show/Hide

This program auto-saves your responses each time you click on a different field. Therefore, you may open and close your application as many times as you like, continue to work on and modify (edit/change/complete) answers to questions and required information, or add or delete uploaded documents, until the application deadline. Application web access will be shut down promptly at the deadline, which is 5:00 p.m. on January 30, 2019.


Application Title/Project Name
Amount Requested Maximum grant amount is $2,000,000, except for the Acute Detox category, which has a maximun grant amount request of $661,341.	$
Total Project Costs Include all costs associated with the project.	$

Applicant Information
First Name
Last Name
Telephone
Email

Organization Information

(changes to this data will be reflected on all other applications for this organization)

Organization Legal Name/Entity Name
Address 1
Address 2
City
State/Province
ZIP+4/Postal Code
Country

Telephone
Fax (optional)
Website (optional)
EIN (XX-XXXXXXX) not being used

Project Manager Contact (can be same as Primary Applicant above)
First Name
Last Name
Title
Email

Item Description	Amount
Budget	(answers are saved automatically when you move to another field)
Sources of Funds
Please fill in the chart below with sources of funds. The total sources of funds must equal the total project costs. Note: Please upload Statements of Commitment for any of the funds listed below in the Documents tab above. Possible sources of funds: Bank loan State of Washington appropriation (how much) Local Option Capital Asset Lending (LOCAL) program through the Office of the State Treasurer https://www.tre.wa.gov/wp-content/uploads/Local-Program-Guide_11.6.2018.pdf/(only for public agencies) Private funds Local resources, including non-Medicaid operating reserves and regional fund balances Other (please briefly explain) Please fill in the chart below with sources of funds. Note: the total sources of funds must equal the total project costs.
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	Total $ 0.00

Use of Funds
Please fill in the chart below with costs. Note: Commerce does not pay for any in-house labor or administrative costs, only project related capital costs.
Item Description	Cost
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	Total $ 0.00

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This application closes at 5:00 p.m. sharp on 01/30/2019.

Documents Requested (please upload as requested in the application)