Corporate Donation Request - Fiscal Year 24
Corporate Donation Request - Fiscal Year 24
Date
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Applicant Information
Organization Name
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Address
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Address
Address
Address
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
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South Carolina
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Tennessee
Texas
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Vermont
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Washington
West Virginia
Wisconsin
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State/Province
Zip/Postal
Zip/Postal
Name of Contact Person
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Name of Contact Person
First
First
Last
Last
Title
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Phone
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Email
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Tax Information
Is your organization an IRS 501(c)(3) non-profit?
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Yes
No
Please Enter Your Organization's Tax Identification Number:
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Please Attach Your Organization's W-9 Form.
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Donation Request Information
Briefly describe the mission of this organization.
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Program/Event Title:
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Date of Program/Event:
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Program/Event Location:
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Which ALCIVIA Corporate Donation Category are you applying under?
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Promoting Agriculture and Rural Youth Leadership Development: ALCIVIA provides support to those members, communities and organizations that seek to promote a positive image of the agricultural industry, promote youth leadership development and ag education, including FFA, 4-H and Ag in the Classroom, Dairy Breakfasts, County Fairs and Farm Tours.
Promoting a ‘Safety First’ Culture: ALCIVIA prides itself on fostering a safe working environment that expands into the communities we serve. Ongoing efforts will be made to support local safety organizations such as police, fire departments, EMS responders and others to keep our communities safe.
Ending Hunger: Support the local efforts of food pantries to end hunger in the communities across our trade territory.
Rural Broadband – Support of initiatives to bring broadband to rural areas for education, health, safety and agriculture business purposes.
Briefly describe how this program/event fulfills the chosen category’s description:
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Requested Amount or Product:
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Payment Deadline:
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Specifically, how will the donation from ALCIVIA be used?
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What form(s) of recognition or promotional opportunities will ALCIVIA receive?
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Acknowledgement
I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that false information may disqualify my organization from receiving a donation.
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I agree
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