Donation Request Form

Northern Star Cooperative Services takes pride in giving back to the communities we serve. We have set up a donation committee to make sure that we are serving our communities and our member-owners in a fair and equitable way.

The donation committee meets monthly to review donations. Please take this into consideration when requesting a donation.

In order to help us expedite your donation procedure, please complete this form in its entirety. In addition, a descriptive letter written on official letterhead of the organization must accompany this form.

Name of Your Organization

Type of Organization

Contact Person

Email Address

example@example.com

Mailing Address

Phone Number

Donation Type Requesting?

MonetaryFoodMerchandise

What is your overall donation goal?

What amount are you requesting?

How much have you raised to date?

When is the donation needed?

How will this donation be used? How many people will it affect?

If this donation is approved, who should the check to written out to?

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