Seeds for Stewardship Application - CHS Larsen Cooperative

How does your organization/project connect to CHS Larsen Co-op?*

(member-owners involved, in community, etc.)

Organization Name*

Organization Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Federal Tax Exempt Number or EIN Number*

Tax Exempt IRS Letter

(if applicable)

Organization's W-9*

Organization Contact

First Last

Title*

Phone*

Email*

Briefly describe the organization you are requesting funds for*

If you are awarded funds, do you agree to complete an evaluation report at the completion of the project?*

Program/Project Budget*

Total Requested Amount*

Title of Program or Project*

Provide a brief summary of the program/project*

(Include how it grows engagement and support of rural communities, agricultural safety, and/or rural youth leadership)

List at least three specific, measurable goals*

How will these goals be measured to determine success?*

Please attach budget of program/project*

Age group*

Any additional attachments to include?

Drop files here or