Charged for Change

Application Form

Please complete the questions below. Applications close on February 22, 2024 at 4:00 p.m. ET

Community Information

Project Information

Proposed Project Sites (please complete the following for each site)

Site One*

Site Two

Site Three

Site Four

Site Five


*A duly authorized signing officer should be an individual who is authorized to apply for this Project on behalf of the Organization and make the acknowledgements and attestations above.

Please send photos of site(s), a detailed project budget and quotes from contractors detailing project expenses to: with subject line “[Community Name] Supporting Documents” by no later than February 22, 2024.

By submitting this application, the applicant confirms that he/she has reviewed the Application Guide and agrees to the terms and conditions as outlined.