SIGNED FINAL 11-2023 Community Foundation Fall 2023 Dental Voucher Grant $2,500

GRANT CONTRACT FALL 2023

ORGANIZATION: PROGRAM TITLE: AMOUNT OF GRANT:

Sauk County Health Department dental vouchers for adults in need
$2,500   FUND: Community Grants

We agree to the following terms as conditions of this grant:

•  The tax-exempt status verified in the grant proposal is still valid; any changes in the 
organization that could lead to a change in the tax-exempt status will be reported to the Community 
Foundation of South Central Wisconsin (CFSCW) immediately.
•  The grant funds will be used solely for the purposes described in the grant request.
•  None of these funds will be used for any political campaign, or to support attempts made to 
influence legislation of any government body other than that which occurs when nonpartisan 
analysis, study and research is made available.
•  The organization will keep and maintain records of expenditures adequate to readily verify the 
proper use of the grant and will provide those records to CFSCW on request.
•  The organization will repay upon demand to CFSCW the amount of the grant, if any condition of 
the grant is not upheld.
•  The organization will credit CFSCW and send CFSCW copies of any printed publicity regarding the 
awarding of the grant or the program supported by the grant.
•  The organization will use the report form provided with the grant check to complete and return a 
final report to CFSCW upon completion of the project or within six months of receipt of the grant, 
whichever comes first. Failure to provide this report may jeopardize your eligibility for future 
grants.
•  The organization authorizes CFSCW to use, reproduce, and/or publish all written and/or visual 
materials, including photographs, which may pertain to the grant project. This information may be 
used in various publications, reports, advertisements, media releases, recruitment materials, 
and/or the CFSCW website.

The terms of this contract are accepted by: