Operation Round-Up Grant Application

Please complete this application by providing the requested information below. Attach any supporting documents, which may include pictures, blueprints, bids, cost estimates, or fundraising information.

Applicants may review Central Electric's Operation Round-Up Grant Guidelines to learn more and help determine if a project is eligible for funding.

The next deadline is October 30th. The recurring deadlines are May 1st and November 1st or the prior business day if the 1st lands on a weekend. The board of trustees awards grants approximately one month after the deadine. Call the office with any questions at 605-996-7516.

Name of Organization

Address of Organization

Street Address

PO Box / Mailing Address (If Different from Street Address)

CityState

Zip Code

Representative Name

First NameLast Name

Representative Title

Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Contact Email

example@example.com

Please indicate the project funding category. You may choose more than one funding category if applicable.

Which county will primarily benefit from the project.

Amount of Grant Request (up to $3,000)

Total Project Cost

Has this organization received an Operation Round-Up grant from Central Electric Cooperative in the past?

Describe the project and how any potential grant funds would be used. Explain how the project will benefit the community and area residents. Projects that will be completed within 12 months are given highest priority. Applicants may attach supporting documents, project details, or photographs.

About the Project

To the best of your knowledge, how many individuals does the organization serve within Central Electric Cooperative's service area?

Who the Project Serves

Please list other funding sources being considered for the project. This may include private donations, fundraisers, existing funds, or other organizations. Click "Add New" to list more than one source.

Optional: Please provide 1-2 local business references that are familiar with the project. By listing a reference, you are granting permission to contact them about the project. Click "Add Row" to list more than one reference.

The information contained in this statement is for the purpose of obtaining funding from Central 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 Central Electric Cooperative, Inc. may consider this statement as continuing to be true and correct until a written notice of a change is provided.

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

As a condition of receiving and accepting grant 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 Central Electric Cooperative Operation Round Up® Fund.

I agree to the terms stated above.

Representative Name

Representative Title

Signature of Representative

Date

File Upload: Please attach any supporting documents below. This may include pictures, blueprints, bids, cost estimates, or fundraising information. If you include any financial documents, please remove or block any account numbers. Call the office with any questions at 605-996-7516.