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Sponsorship & Donation Application Applicants are requested to submit a complete application form. Please type or print in black ink. Attachments may be necessary due to space limitations. Attachments should be paper clipped to the application forms. Applications should be submitted a minimum of three (3) weeks prior to funding needs. While Powder River Energy Corporation will review applications as quickly as possible, there are several standards/criteria that need to be considered and evaluated which may take time for processing. When applying for either Sponsorship or Donations, please note the following guidelines: • Sponsorship requests can be for any amount and are considered directly by PRECorp’s Marketing Communications Division. • Donation requests under $500 will be reviewed by PRECorp’s Community Involvement Committee. Donations, grants, or charitable requests over $500 should be sent directly to the Powder River Energy Foundation for consideration (Section B of this form will need to be completed.)

Organization Information: Name______________________________________________________ Name of Organization:_________________________________________ Address:___________________________________________________ City:_______________________ State:___________ Zip:______________ Phone:_________________________________ Fax:_______________________________ Email:__________________________________________ Request: Select the type of request: Direct Monetary Support or Donation

Direct Sponsorship

Powder River Energy Foundation donation request (Also complete Section B of this form.) Advertising (Please attach specifications, publication use, the number of copies, and distribution.) Door Prize, Raffle Prize or Auction Item

Promotional Items

Other (Provide a brief description.)

What is the amount of the request?_________________ What is the ultimate goal?___________________________________________________ What date is this request needed?_________________________________ What is the date of the event?_______________________________ Is this event held annually?

Yes

No

How many people are estimated to attend?_______________________________

How will this event be promoted or advertised?________________________________________________________________________________

I am currently an Operation RoundUp® participant I would like information on enrolling in Operation RoundUp® Has this organization received notice from the Internal Revenue Service of a tax-exempt ruling or determination under Section 501 (c)(3) of the Internal Revenue Code? Yes (Please supply a copy of such ruling with this application form.)

No

Describe your organization and its purpose:

SUNDANCE – CORPORATE HEADQUARTERS 221 Main Street • P.O. Box 930 • Sundance, WY 82729 (800) 442-3630 Phone • (307) 283-3527 Fax

GILLETTE 200 Garner Lake Road • P.O. Box 937 • Gillette, WY 82718 (800) 442-3630 Phone • (307) 682-0733 Fax

www.precorp.coop

SHERIDAN 1095 Brundage Lane • P.O. Box 5087 • Sheridan, WY 82801 (800) 442-3630 Phone • (307) 674-9018 Fax


Describe the event:

Describe how sponsors or donors are recognized:

What benefits will sponsors or donors receive?:

Describe how this event will benefit the community (include how the request will be used):

Completion and Evaluation: I acknowledge that all of the information in the application is true to the best of my knowledge. I certify that the request applied for will benefit charity or a non-profit purpose. Authorized Signature:_______________________________________________________________________ Date:_______________________ Title:___________________________________________________________________________________________________________________ Please return completed application to Marketing Communications Division at PO Box 930, Sundance WY 82729 or communications@precorp.coop. For more information, please visit www.precorp.coop.

For Powder River Energy Corporation/Foundation comments only: Received By:___________________________________________________________________ Received Date:_______________________ Reviewed By:_________________________________________________________________________________________________________ Marketing Communications Division Request Approved

Community Involvement Committee

Request Denied

Powder River Energy Foundation

Reason:__________________________________________________________________

Donation Description:_______________________________ Amount:___________________ Check Requested:_______________________

Signature:_______________________________________________________________________________ Date:________________________

SUNDANCE – CORPORATE HEADQUARTERS 221 Main Street • P.O. Box 930 • Sundance, WY 82729 (800) 442-3630 Phone • (307) 283-3527 Fax

GILLETTE 200 Garner Lake Road • P.O. Box 937 • Gillette, WY 82718 (800) 442-3630 Phone • (307) 682-0733 Fax

www.precorp.coop

SHERIDAN 1095 Brundage Lane • P.O. Box 5087 • Sheridan, WY 82801 (800) 442-3630 Phone • (307) 674-9018 Fax


Section B Foundation Application 1. Please tell us how you heard about the PRECorp Foundation:

2. Please provide a copy of the previous year’s financial statement(s) Statement attached: Yes

No

3. Number of individuals, families, or groups served in Campbell, Crook, Johnson, Sheridan, or Weston counties in the last year:

4. Does your agency serve outside Campbell, Crook, Johnson, Sheridan, or Weston Counties? Yes

No

If yes, please provide information on number served and location:

5. State Purpose of Organization/Agency request: (Specifics of how funds will be used)

6. List other sources of funding that will be combined with the request described above:

SUNDANCE – CORPORATE HEADQUARTERS 221 Main Street • P.O. Box 930 • Sundance, WY 82729 (800) 442-3630 Phone • (307) 283-3527 Fax

GILLETTE 200 Garner Lake Road • P.O. Box 937 • Gillette, WY 82718 (800) 442-3630 Phone • (307) 682-0733 Fax

www.precorp.coop

SHERIDAN 1095 Brundage Lane • P.O. Box 5087 • Sheridan, WY 82801 (800) 442-3630 Phone • (307) 674-9018 Fax


7. How are your agency’s programs measured for effectiveness?

7. Please list three references: #1. Name____________________________________ Title/Relationshipto applicant______________________________ Phone______________________________ Address___________________________________________________________ City__________________________________State___________________________________ Zip_______________________ #2. Name____________________________________ Title/Relationshipto applicant______________________________ Phone______________________________ Address___________________________________________________________ City__________________________________State___________________________________ Zip_______________________ #3. Name____________________________________ Title/Relationshipto applicant______________________________ Phone______________________________ Address___________________________________________________________ City__________________________________State___________________________________ Zip_______________________ Completion and Evaluation: The information contained in this statement is for the purpose of obtaining funds from the Powder River Energy Corporation Foundation, Inc. on behalf of the undersigned. Each undersigned understands that the information provided herein is used to determine grant funding, and each undersigned represents and warrants that the information provided is true and complete, and that the Powder River Energy Corporation Foundation, Inc. may consider this statement as continuing to be true and correct until a written notice of change is provided. The Powder River Energy Corporation Foundation, Inc. is authorized to make any inquiries deemed necessary to verify the accuracy of the statements made herein. Authorized Signature: __________________________________________________ Date: ___________________________ Name of Organization: __________________________________________________________________________________

SUNDANCE – CORPORATE HEADQUARTERS 221 Main Street • P.O. Box 930 • Sundance, WY 82729 (800) 442-3630 Phone • (307) 283-3527 Fax

GILLETTE 200 Garner Lake Road • P.O. Box 937 • Gillette, WY 82718 (800) 442-3630 Phone • (307) 682-0733 Fax

www.precorp.coop

SHERIDAN 1095 Brundage Lane • P.O. Box 5087 • Sheridan, WY 82801 (800) 442-3630 Phone • (307) 674-9018 Fax


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