1. Name of Organization:

2. Address:

3. Contact Person:

4. Phone:

5. Is Organization: ___For Profit ___Non-Profit ___501c3 If non-profit

6. Organizational History/Purpose:

7. Organizational Programs and Results:

8. Number of individuals, families or groups served annually:

9. Geographic area served:

10. Does organization utilize volunteers? ___Yes ___No
Explain:

11. Amount Needed

from Community Trust

$ ____________

for Total Project

$ ____________

12. Describe the project:

14. Other funding sources and their contributions:

15. Attach a copy of financial statements for three years (prior year’s actual, current year’s estimate and next year’s budget. ___ Statement attached
The information contained in this application is for the purpose of obtaining funding from the Mille Lacs Electric Community Trust on behalf of the undersigned. We understand that the information is confidential, for the Trustees review only. The information provided is true and complete.

Name of Organization ___________________________________________

Signature (title) ____________________________ Date _____________