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COMMUNITY GIVING REQUEST
Thank you for your interest in United Cooperative's Community Giving program. Please note the application does not save your progress and required fields are indicated.
*Required Fields
Applicant Information
Organization Name:
*
We're sorry, we do not provide support to individual benefits, religious organizations, political parties or political candidates.
Address:
*
City, State Zip:
*
Name of Contact Person:
*
Title:
*
Phone:
*
Email Address:
*
Tax Information
Is the Organization an IRS 501(c)(3) nonprofit?:
*
Yes
No
Please enter your Organization's Tax Identification Number:
Please attach your Organization's W-9 Form:
Personal Information
Briefly describe the mission of this organization:
*
Program/Event Title:
*
Program/Event Location:
*
Date of Event:
*
Which United Cooperative donation category are you applying under?:
*
Promoting Agriculture and Rural Youth Leadership Development: 4-H, FFA, Dairy Breakfasts, etc.
Promoting Safe Communities: police, fire departments, EMS responders, etc.
Ending Hunger: Support the local efforts of food pantries to end hunger in the communities across our trade territory.
Briefly describe how this program/event fulfills the chosen category’s description:
*
Amount Requested:
*
Payment Deadline:
*
Please note: donation requests are reviewed on a monthly basis. Please allow 4-6 weeks before your donation deadline or event.
Specifically, how will the donation from United Cooperative be used?:
*
What form(s) of recognition or promotional opportunities will United Cooperative receive?:
*
Security code: