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

Please do not upload files containing personal identifiable information (PII). This includes but is not limited to SSN, credit card number, driver's license number, or taxpayer ID.

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: