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
Briefly describe the history your organization has with the cooperative*
Briefly describe other community giving/volunteer efforts your organization has involved the cooperative with.*
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?*
- Yes
- No
Program/Project Budget*
Project Start Date*
Date Format: MM slash DD slash YYYY
Project End Date*
Date Format: MM slash DD slash YYYY
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*
- Adults
- College
- Youth
Any additional attachments to include?
Drop files here or
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