Donation Request form

Donation Request

Contact Information

Name of Organization / Group *

Primary Contact Person *

Primary Contact Phone *

Email *

Organization Mailing Address *

City *

Enter ZIP Code *

Website Address

Organization Details

Organization / group mission statement or purpose * *

Geographic area or individuals your organization serves. * *

Is your organization / group a recognized non-profit entity? *

Yes

No

If yes, please enter your 9-digit EIN / Tax ID number.

Are you or any of your organizational team current MEMBERS1st members? * *

Yes

No

If yes, please describe any personal or business relationships you may have to MEMBERS1st or any MEMBERS1st Team Members.

Has your organization previously requested support from MEMBERS1st? *

Yes

No

Funding Request Details

Please provide a brief description of the purpose or event for which support is being requested. *

Who will benefit from this request and how will the funds be used? *

How do you feel this request supports MEMBERS1st CCU's mission of Financially Empowering Central Iowa? *

Amount being requested *

When are the funds needed? *

If noted as 'other,' please provide details

Are there any other ways MEMBERS1st may provide support (ex: giveaway items, co-op promotion, etc.)?

What type of recognition, if any, will MEMBERS1st receive as a result of our support? *

Additional / Supporting Documents

Are there tiered giving/sponsorship levels? If so, please provide what each giving/sponsorship level entails. *

If this is an annual event, what was the attendance last year? *

What is your organization's annual budget? *

If you wish to provide additional support documentation for review purposes, please upload here (2 items, jpg or PDF file format, 2MB max size).

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