Application For Funding

Directions: Please complete the application and include supporting documentation. If you need assistance, please contact us.

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This field is for validation purposes and should be left unchanged.

Organization Information

Organization Name(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Daytime Phone(Required)

Contact Person Name(Required)

First Last

Contact Person Title

Email Address(Required)

Is the organization exempt from payment of income tax?(Required)

Yes

If “Yes,” please attach a copy of your 501(c)(3) letter from the Internal Revenue Service.(Required)

Max. file size: 50 MB.

Please provide your financial statement for the most recent year.(Required)

Max. file size: 50 MB.

Number of individuals, families, or groups in the Farmers EC service area your organization assisted last year?(Required)

(Farmers EC serves parts of eastern Dallas, Collin, Rockwall, Hunt, Kaufman, Rains, Hopkins, Delta, Franklin, Fannin, Van Zandt, and Wood counties.)

Does your organization serve locations outside the Farmers EC service area?(Required)

Yes

If so, where?

Amount Requested(Required)

State the purpose of your organization’s funding request and details of how the funds will be used.(Required)

Please list other sources of funding for the purpose(s) described above.(Required)

How are your organization’s programs measured for effectiveness?(Required)

References

Directions: Please list 3 references who are not directors or employees of Farmers Electric Cooperative or the Farmers Electric Charitable Foundation.

Reference 1

Reference Contact Name 1(Required)

First Last

Daytime Phone

Email Address

Street Address

Street Address City State ZIP Code

Reference 2

Reference Contact Name 2(Required)

First Last

Daytime Phone

Email Address

Street Address

Street Address City State ZIP Code

Reference 3

Reference Contact Name 3

First Last

Daytime Phone

Email Address

Street Address

Street Address City State ZIP Code

Applicant Signature (Full Name)(Required)