Community Involvement Request Form

We are celebrating our 75th birthday this year. As part of this celebration, we have chosen to donate $1,000 to 75 nonprofit organizations across the state during the course of the year. To be considered for one of the 75 donations, please complete this form in its entirety and click the "Submit" button below. In order to allow time for review, please submit requests at least 30 days prior to the date the donation is needed. Other requests are welcome, however funding will be limited on other types of requests.

All fields are required.




Name of Organization:

Name of Contact:

Address:

City, State, Zip:

   

Email Address:

Telephone Number:




Amount or item requested:
Referred by:
Date of event:
 
Purpose of request:
 
Please identify advertising/promotional opportunities that accompany this request: