Operation Round Up Grant Application

Applicant Information

Date of Application

Organization Name

Classification

Individual/Family

Non-Profit

If organization is non-profit, are you a 501c3? (if no, you may still apply)

Yes

Primary Contact First Name

Primary Contact Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email address for primary contact

Organization website

Primary Contact Phone Number

Please fill out the following information for the primary contact for this grant application.

Mailing Information

Checks made payable to

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Project Description

Type of Request

Personal

Community

Total cost of project

Amount Requested

Time frame in which funds are needed

Have you requested funds from any other sources?

Yes

If yes, please list the sources.

How would Operation Round Up funds be used?

What are the benefits to the community or area?

Applicants may apply for and be awarded grant amounts up to:

Individuals - $3,000
Family Units - $5,000
Organizations - $10,000

Grant awards will not exceed the above amounts annually for any one individual, family unit or organization.

Contributions will generally not be made for lobbying, political and religious organizations.

Does your check need to be made out to another organization or sent to a different address than listed above? If yes, please fill out the information in this section. If no, please skip to the Project Description section.

Organizations Only - Required Attachments

IRS Tax Determination Letter (501c organizations only)

One file only.
20 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.

Organizational budget (current fiscal year)

One file only.
20 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.

Copy of Tax Form 990 (501c organizations only)

One file only.
20 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.

Please attach a copy of the following documents to your application:

IRS Tax Determination Letter
Organizational Budget (current fiscal year)
Copy of Tax Form 990

If you have any issues attaching documentation, please contact us at grants@scec.coop.

Personal Applicants Only - Required Attachments

Copy of the Project Estimate

One file only.
20 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.

Please include a copy of the following document with your application:

Copy of the project estimate

If you have any issues attaching documentation, please contact us at grants@scec.coop.

Signature

Signature Box

By signing this form I agree that the information above is correct, and I have the authority to submit this application.

Title

Date

St. Croix Electric Cooperative

Office Hours

Contact Info

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