Common Cents Application for Donation

Common Cents Application for Donation

The Common Cents Board meets the first week of March, June, September and December. Applications are due by noon of the first day of these months.
Common Cents, a 501 (C) non-profit entity operated separately from Red River Communications, awards funds to local non-profit and community organizations and offers emergency & medical assistance for local individuals. The board of directors meets quarterly to review applications; if you are interested in applying, please download and return the form below.

Common Cents Program Details:
- The program is overseen by a volunteer Board of Directors who meet quarterly to review applications.
- It awards funds to local non-profit and community organizations and offers emergency & medical assistance for local individuals.
- Common Cents is funded by our customers when they round up their bills to the next dollar. These tax-deductible contributions average $0.40 per month.
  Nearly 60% of our customers contribute to Common Cents.
A separate volunteer Board of Directors of Red River Communication’s members oversees the Common Cents fund. It meets quarterly to review applications and approve donations. Thank you, board members, for your time and talents!
Organization/Individual Information
Does this request come from an individual or an organization?*

IndividualOrganization
Organization Name*
Main Contact Name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Is the organization exempt from payment of income tax?*

YesNo
Does this organization receive taxpayer funds?*

YesNo
If yes, please explain the taxpayer funds you receive:
If yes, please attach a copy of Form 501(c) 3 from the IRS.

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How many individuals, families, groups or towns served within Red River Communications' service area within the last year? (Please reference redrivercomm.com/find_services to see current service area)*
Does your organization serve OUTSIDE the Red River Communications service area? (Please reference redrivercomm.com/find_services to see current service area)*

YesNo
If yes, please explain below:*

Donation Request Details

Please complete each question completely.
State purpose of the request (please include as many details about the project/request as possible):*
Anticipated Project Expense:*
Bids*

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Expense Breakdown:*

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Funds needed for project completion:*
Amount Requested from Common Cents:*
Money on Hand for Project:*
Other Documents:

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Other Documents:

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List sources of funding and amount of funds raised thus far for this project/request:*

Individual Emergency or medical assistance requests:

Please answer each question completely.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Is the applicant a member of Red River Rural Telephone Association (DBA Red River Communications)*

YesNo
Amount Requested from Common Cents:*
State purpose of the request (include amount requested and specific use of funds):*

Disclaimers and Submit Application
The information contained in the statement is to obtain funding from Red River Communications' Common Cents grant program on behalf of the undersigned.

Each undersigned understands that the information provided herein is used in deciding to grant funding, and each undersigned represents and warrants that the information provided is accurate and complete and that Red River Communications' Common Cents Board of Directors may consider this statement as continuing to be accurate and correct until a written notice of a change is provided. Red River Communications' Common Cents is authorized to make all necessary inquiries to verify the accuracy of the statements made herein.

The applicant agrees to share information provided herein with other organizations/agencies by Red River Communications' Common Cents Board of Directors and to return the funds if said project is not completed.
First and Last Name of Signee (Organization Representative)*
Title of Representative *
Signature*

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Common Cents Application for Donation

Organization/Individual Information

Donation Request Details

Individual Emergency or medical assistance requests:

Disclaimers and Submit Application