Community Connection Fund Application

Community Connection Fund Grant Application

Name of Group/Organization

Address

City/Town

State/Province

ZIP/Postal Code

Contact Person

Daytime Phone number

Evening Phone number

Amount Requested

Proposed use of funds

State type of group/organization, ownership, non-or-for-profit, and tax status. If exempt from payment of income taxes, please attach form 501(c)3 letter from Internal Revenue Service.

UPLOAD 501(c)3 from IRS

One file only.
5 MB limit.
Allowed types: pdf doc docx.

UPLOAD financial statements, including sources of income, for one previous year.

One file only.
5 MB limit.
Allowed types: pdf doc docx.

IS YOUR GROUP/ORGANIZATION RECEIVING OR REQUESTING ANY OTHER FORM OF ASSISTANCE FOR STATED REQUEST? (donation, grant, etc)

Yes

List all other forms of assistance or aid your group/organization is receiving or requesting.

Number and location of individuals, families, or groups your organization serves OUTSIDE of the Midwest Electric service area.

Will these funds be used to support any candidate for public office or any political purpose?

Yes

How are your group's programs measured for effectiveness?

Number of individuals, families, or groups your organization currently serves WITHIN the Midwest Electric service area

Community Connection Fund Grant Application

Main Office

Phone Numbers