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Community Fund Form

Every space needs to be completed, and a financial statement MUST be attached (unless otherwise stated).

*Capital Improvement Projects are not allowed and will not be funded*

Next Quarter Application Due Date:  June 19, 2024
Community Fund Online Application
Physical Address of Organization
Physical Address of Organization
City
State/Province
Zip/Postal
Mailing Address (if different)
Mailing Address (if different)
City
State/Province
Zip/Postal
Is organization exempt from payment of income tax?
Is organization deemed a Not for Profit approved by IRS?
$
Please include a decimal point - Whole dollars only

Maximum file size: 32MB

Accepted file types are: pdf, docx, xlsx, jpg, jpeg, png, gif
1666 West State Road 54
Bloomfield, Indiana 47424

Hours:  Monday – Friday, 7:30 a.m. to 4:30 p.m.

Office: (812) 384-4446
Toll-Free: (800) 489-7362
©2021 Utilities District of Western Indiana REMC. Member-Owned. Member-Focused.