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Community Giving Request Form
SECTION A:  General Information
Organization Name:  
Contact Name:  
Contact Title:  
Contact Phone Number:    
Contact Email:    
Website:
Are you a:  

Has your organization received funding from CUMIS or The Co-operators in the past?  

SECTION B:  Detailed Information

1.  Please provide a brief synopsis of your organization.

2.  Briefly describe what you plan to do and how funding from CUMIS will be used. Please outline the following:

  • Goals and objectives of the project including the community need for the program
  • How the project supports the criteria listed above
  • Project work plan, timeline and budget
  • What you are requesting from CUMIS

3.  Briefly describe your plan for evaluating the goals and objectives of the project. What are the expected outcomes, both short-term and long term.

4.  Which other companies and organizations are involved with supporting your organization and/or this project?

Has your organization requested funding from any other Co-operators or CUMIS offices?  

5.  Are there any employees from CUMIS involved in the project/organization?  

6.  How will CUMIS be recognized for its contributions to the project/organization? Please list all advertising, staff involvement and promotional opportunities.