Organization Name

Check Payable To (organization name as it should appear on the check)

Organization’s Mailing Address

City

State

Zip Code

Contact Person (First and Last Name)

Contact Person’s Email Address

Contact Person’s Phone Number

MATCHING FUNDS

In order to apply for matching funds from our vendor partners, funds must be given to a 501c3 organization, educational institution/school, or government entity/municipality

If your organization does not meet these criteria, you may partner with one of the approved organization types listed above to receive the funds on your behalf (with their approval)

Please complete the section below using the information for the approved organization

If the organization listed in the first section qualifies as an approved organization, you may repeat that information below

Name of nonprofit organization, educational institution/school, or government entity

Nonprofit’s 9-digit Employer Identification Number (EIN) (Also known as a federal tax identification number)

Numbers only, no dashes (Example: 123456789)

(Required for Funds Eligibility)

Organization’s Mailing Address

City

Sate

Zip Code

Contact Person (First and Last Name)

Contact Person's Email

Contact Person's Phone Number

Contact Person's Title at Organization

Briefly describe the project you are requesting funding for (include project goals, timeline, and expected completion date)

Briefly describe the impact this funding would have on your organization and the community you serve

Please provide a short overview of your organization, including your mission and the areas you serve

Dollar Amount Requested

Numbers only, no dollar sign or punctuation (Example: $1,000.00 should read 1000)

Do you have any supporting documentation you want to share as part of your request? (Examples: project budget, photos, letters of support, flyers, etc.)

Upload supporting documentation below

Please select a file

Security Code

Farmers Cooperative Hunger Program Application