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LCEC & COBANK’S “SHARING SUCCESS” MATCHING GRANT PROGRAM APPLICATION FORM
Once completed, please return to Celeste Holt or Rosie Insilan at Lea County Electric Cooperative, Inc. via USPS: PO Drawer 1447, Lovington, NM 88260, E-Mail: rinsilan@lcecnet.com, or in person at any of our three offices. Applications with required documentation must be received by end of business day on Friday, June 2nd, 2023.
Please contact Rosie Insilan directly with any questions by calling 575-396-9620.
Nonprofit Organization Name
contact information
Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
TIN (Taxpayer Identification Number)
Contact Name
Contact Title
Contact Phone Number
Email
Intended use of gift (Please provide a brief description of the organization, program, and intended use of the contribution. You may attach documents if necessary.)
Proof of the nonprofit organization’s 501(c)(3) status must be provided with this application. Select organizations that are not designated a 501(c)(3) are also eligible. These organizations include schools and government organizations such as counties or municipalities and their agencies or departments, as long as the donation serves a public purpose and is consistent with the purpose and guidelines of the Sharing Success program. If the recipient is not a 501(c)(3), please submit the organization’s TIN (taxpayer identification number). Matching funds are contingent upon availability of funds from CoBank.
Applicant’s Signature
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Date
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