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:

Please select a file

Proposal 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: