Corporate Mission Fund Application
Name of Organization Requesting Funding:
*
State
*
Georgia
North Carolina
South Carolina
NC County
*
Please Select
Alamance County
Alexander County
Alleghany County
Anson County
Ashe County
Avery County
Buncombe County
Burke County
Cabarrus County
Caldwell County
Caswell County
Catawba County
Chatham County
Cherokee County
Clay County
Cleveland County
Davidson County
Davie County
Durham County
Forsyth County
Gaston County
Graham County
Guilford County
Haywood County
Henderson County
Iredell County
Jackson County
Lee County
Lincoln County
Macon County
Madison County
McDowell County
Mecklenburg County
Mitchell County
Montgomery County
Moore County
Orange County
Person County
Polk County
Randolph County
Richmond County
Rockingham County
Rowan County
Rutherford County
Stanly County
Stokes County
Surry County
Swain County
Transylvania County
Union County
Watauga County
Wilkes County
Yadkin County
Yancey County
SC County
*
Please Select
Abbeville
Aiken
Allendale
Anderson
Bamberg
Barnwell
Beaufort
Berkeley
Calhoun
Charleston
Cherokee
Chester
Colleton
Dorchester
Edgefield
Fairfield
Greenville
Greenwood
Hampton
Jasper
Kershaw
Lancaster
Laurens
Lexington
McCormick
Newberry
Oconee
Orangeburg
Pickens
Richland
Saluda
Spartanburg
Union
York
GA County
*
Please Select
Appling
Atkinson
Bacon
Brantley
Bryan
Bulloch
Butts
Camden
Candler
Carroll
Charlton
Chatham
Clayton
Clinch
Coffee
Coweta
DeKalb
Douglas
Effingham
Emanuel
Evans
Fayette
Fulton
Glynn
Greene
Gwinnett
Haralson
Harris
Heard
Henry
Jasper
Jeff Davis
Jenkins
Lamar
Liberty
Long
McIntosh
Meriwether
Monroe
Montgomery
Morgan
Muscogee
Newton
Oconee
Pierce
Pike
Putnam
Rockdale
Screven
Spalding
Talbot
Tattnall
Toombs
Troup
Upson
Walton
Ware
Wayne
Wheeler
Organization Structure (Check all that apply)
*
501c(3) Not-for-Profit
Unit of Government
Public Agency
Community Organization
Please provide a brief 1-2 sentence project description (should be suitable for use in a press release - 500 character limit)
*
0/500
Please provide the full purpose and description of your project including who it will benefit (1000 character limit):
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0/1000
Amount Requested from AgSouth Growing Our Communities Grant:
*
Enter whole dollar amounts only.
Total Project Budget:
*
Enter whole dollar amounts only.
Starting Date of Project (must be after 1/1/2025)
*
-
Month
-
Day
Year
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Ending Date of Project (must be by 12/31/2025)
*
-
Month
-
Day
Year
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Project Category
*
Please Select
4-H
Agritourism
College Agriculture Extension
Faith Based/Therapy
Farmers Market
FFA
Fire & Rescue
FoodHub/CSA/Community Garden
Food Pantry
K-12 Ag Education
Local Community Organization
Natural Resources
Outdoor/Guided Hunting
Rural Preservation/Rural Infrastructure
Therapeutic Horseback Riding
Youth Program
Other
If other, please describe:
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Organization Website:
Contact Person:
*
Contact Title:
Contact E-mail Address:
*
example@example.com
Contact Phone Number
*
Project Location / Organization Physical Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Organization Mailing Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please provide a brief summary of your organization including the history, organization description, mission and goals (500 character limit):
*
0/500
Please describe the population and geographic area served by your organization (250 character limit):
*
0/250
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Has your organization been a recipient of a Farm Credit grant in the past?
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Yes
No
If yes, what year(s) did your organization receive a grant?
*
If yes, provide a short description of the projects funded by any Farm Credit grants your organization has received.
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0/250
Other Funding Organizations
Other Funding Organization #1
Other Funding Organization Supporting this Request:
Amount:
Enter whole dollar amounts only.
Committed or Pending:
Committed
Pending
Other Funding Organization #2
Other Funding Organization Supporting this Request:
Amount:
Enter whole dollar amounts only.
Committed or Pending:
Committed
Pending
Other Funding Organization #3
Other Funding Organization Supporting this Request:
Amount:
Enter whole dollar amounts only.
Committed or Pending:
Committed
Pending
Please attach the appropriate W-9 form:
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