CoBank Sharing Success Application

Organization Name

Contact Person (First and Last Name)

Contact E-mail

Contact Phone Number

Organization Physical Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Organization Mailing Address (if different)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

501c3_Status

Has the organization received notice from the Internal Revenue Service of a tax-exempt ruling or determination under Section 501 (c)(3) of the Internal Revenue Code?

Yes: If yes, please supply a copy of such ruling by attaching below, or supply to Lane-Scott Electric at PO Box 758, Dighton, KS 67839

No: If no, supply your Federal Tax Identification Number below

Federal Tax Identification Number

501c3 Documentation

Upload requirements

Describe Your Organization and its Purpose

What geographical area does your organization impact?

Explain what the grant would be used for. How would it impact your organization?

When do you expect the project to be completed?

Who will the project benefit?

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