Organization Name

501(c)(3) or cooperative corporation number:

Mission Statement

Contact Person:

Title

Mailing Address:
Address Line 1

Address Line 2

City

State

Zip Code

Street Address (if different)

Phone #:

Email

Website (optional)

Would funds be used for core operating support or project/event support?
Core Operating SupportProject/Event Support

Program Area(s) (Please check all that apply.):
Arts & CultureCommunity Health & WellnessCo-operative BusinessDiversity, Equity & InclusionEnvironmentFood & AgricultureLocal Area SchoolsLocal Business & EconomySocial Issues

Letter of Interest - Please upload a letter of interest that is no longer than two pages. Your letter should address the following:
o The issue(s) the organization or project will address.
o How Cooperative Community Funds will be utilized to address the identified issue(s) listed above (please include specific strategies, approaches and activities).
o How the proposed work aligns with BriarPatch Food Co-op’s Ends Policies.
o How your organization is addressing diversity, equity and inclusion. If your organization is not currently addressing this, what are the barriers, such as knowledge, financial restrictions, capacity, etc. that are preventing you from doing so?
o Two key accomplishments of the organization in the past 12 months.

File Upload:

Please uploaded completed Form W-9:

Please uploaded completed Vendor Form:

Please upload a high-resolution logo: