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Operation Round Up® Application Form

Legal Organization Name*
FEIN#*
Address*
Street Address Address Line 2 City State ZIP Code
Contact Person*
First Last
Phone*
Email*
Title/Position/Affiliation with Organization or Event*
Purpose of Organization/Event*
Amount Requesting*
How Will The Funds Be Utilized?*
Explain How Your Organization/Event Serves The Members of Missoula Electric Cooperative.*
Has Your Organization Previously Applied For Funding?*
If You Answered Yes, Please List the Amount/Years Your Organization Has Received Funding In The Past Five Years.
If You Previously Applied For Funding, When and For What Purpose?
List an *OUTSIDE* Business Reference Familiar With The Organization or Event.*
First Last
Reference Phone*
Reference Email*
List a Second *OUTSIDE* Business Reference Familiar With The Organization or Event.*
First Last
Reference Phone*
Reference Email*
Date Funds Are Needed*
MM slash DD slash YYYY

Please note - you MUST request funds at least one quarter PRIOR to when you need them. Applications will be reviewed on a quarterly basis and donations may be considered for up to one year.
If Selected, Please Make Checks Payable To:*
Organization Name
If Selected, Please Mail Check To The Following Address:*
Street Address Address Line 2 City State ZIP Code
Consent*
I agree to the stated terms.
The information contained in this statement is for the purpose of obtaining funding from Missoula Electric Cooperative, Inc.’s Operation Round Up® fund. The undersigned understands that the information provided herein is used in deciding grant funding, and the undersigned represents and warrants that the information provided is true and complete and that Missoula Electric Cooperative, Inc. may consider this statement true and correct until a written notice of change is provided.

Missoula Electric Cooperative and the Operation Round Up® Board are authorized to make all inquiries deemed necessary to verify the accuracy of the statements herein.

As a condition of receiving and accepting these funds, the undersigned agrees that all funds will be used for the project approved and as stated on the application. Any funds not used shall be returned to the Missoula Electric Cooperative Operation Round Up® fund.
Please complete and upload a W-9.*
Max. file size: 20 MB.
If your organization is exempt from payment of income tax, please upload a Determination Letter or other documentation stating exempt status.
Max. file size: 20 MB.
If you are not exempt from payment of income tax, please tell us how your request would further ORU's charitable purpose.
Supporting Documents
Please upload any supporting documents that might help the ORU Board make their decision (i.e. event flyer, sponsorship packets, etc.).
Drop files here or

Max. file size: 20 MB.

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