Application and supporting materials are due by 5:00 PM on Monday, March 6, 2017.
Please use this computer generated form.
Completed application should be submitted online.
Form may also be printed for your records before you submit the application.
Main contact person for this application and program. Please list information for the person to be contacted regarding this application.
2015 Funding Request
Please be sure that your application includes copies of the documents listed below.
Failure to include these documents may result in denial of this application.
You may attach the documents below or send them to either HHS@desplaines.org or fax to 847.827.2292.
Certification of Information
I certify that the information provided is true to the best of my knowledge. I am also aware that this information is subject to review and verification and I may have to provide documents to support this application. I am also aware that any misstatements or false facts could result in denial of the application.
*indicates required fields.