Farmers Cooperative Hunger Program Application

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

Nonprofit’s Employer Identification Number (EIN)

Organization’s Mailing Address

City

State

Zip Code

Contact Person's (First & Last Name)

Contact Person's Email Address

Contact Person's Phone Number

Contact Person's Title at Organization

Briefly describe the project you are requesting funding for

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

Please provide a short overview/history of your food pantry or backpack program, including the areas you serve (Ex. Number of people your organization serves and towns/counties you cover)

Dollar Amount Requested

Do you have any supporting documentation you want to share as part of your request? If so, please upload it below