Land O'Lakes Foundation

Land O'Lakes Foundation Community Grants Program Application Form
Complete the form below to recieve an application by mail or continue to complete the application online.
Click Here: for printable form.

Name of Organization: Date:
Address-Street:
City: State: Zip:
Daytime Phone: ( ) -	Evening Phone: ( ) -
Email:
Contact Person:	Contact Title:
Employer Identification Number (EIN):

THE AREA PICKED IS FUNDED BY THE LAND O'LAKES FOUNDATION. PLEASE COMPLETE THE REST OF THE FORM BELOW.
Check the program area that best describes this grant request. Please check only one:
Human Services		Arts		Youth and Education
	Programs that work to alleviate hunger		Performing Arts		Rural youth leadership
	United Way, federated fund		Visual, museums		Business/ag education
Civic			Umbrella/regional arts organization
	Groups that work to solve community problems or capture opportunities		Film, literature, broadcast

Amount requested from Land O'Lakes Foundation:

State organization's mission and briefly describe the purpose of this request:

Why is it needed?:

State expected results:

Organizational Budget for current fiscal year:

Project Budget for current fiscal year:

Percent of current year income contributed:

Percent of current year income earned (fees/contracts for services):

Number of clients/patrons served:

Number of staff:

Full time

Part time

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