Company name

​​Cobb EMC Foundation

Request for ANNUAL PARTNERSHIP AWARD Funding for Non-Profit Organizations

Annual Award Application for NEXT YEAR 

1. Name of the Organization: **
2. Physical address of charitable location requesting funding: **
City **	State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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	Zip Code **
3. Mailing Address (Street or Post Office) if different than above: *
City *	State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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	Zip Code *

4. Type of Charity: Family, Children & Youth Animal Welfare Education, Literacy Schools Military & Veterans Health Food & Nutrition Housing Arts, Culture & Humanities Workforce Development Public Safety
5. Contact Name & Title: **	6. Person Filing out Form (if different from above): *
7. Email Address ***
Phone Number (daytime): **	Cellphone **
8. Organization Website *
9. Does organization serve the Cobb EMC service district? Please see map below. Y/N * 9. Does organization serve the Cobb EMC service district? Please see map below. Y/N No9. Does organization serve the Cobb EMC service district? Please see map below. Y/N Yes

10. Number of individuals, families, or groups served in Cobb EMC Service District, in the last year: ***
11. What is your Annual Operation Budget? **
12. Please provide a 1-2 sentence description of your organization’s mission for use in our marketing materials. **
13. State or list the specific programs, services, initiatives and/or events for which your organization is requesting funding for Next Year. If the request includes sponsorship of events, please include the dates and deadline funds are needed. List initiatives in order of importance. **
For each of the programs /events, please note sponsorship levels (gala/auction, golf tournament, awards ceremony, etc.) and benefits. **
14. How are the organization’s programs in the application measured for effectiveness? **
15. Total Amount Requested for next year: ***
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Name of the Organization: **
Date **
Signature **

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