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Midwest Dairy Grant Application
Eligbility
Select one of the following:
Select one of the following:
Dairy farmers contributing to Midwest Dairy checkoff
Select one of the following:
Organized Dairy Group (a dairy farmer currently contributing to Midwest Dairy checkoff must serve on the board)
Select one of the following:
Agriculture Organization (FFA, Farm Bureau, 4-H, etc.)
Please select one of the following Midwest Dairy Divisions:
Illinois
Iowa
MoKan (Northern Missouri, Kansas)
Minnesota
Nebraska
North Dakota
Ozarks (Arkansas, Southern Missouri, Eastern Oklahoma)
South Dakota
APPLICANT INFORMATION
All applicants are required to submit a W9 form to Midwest Dairy for payment using our secure site. If the name or business name and address information on the W9 does not match the Check Payable To and Mailed To information at the bottom of the application, the review process for your grant will be delayed.
First Name
Last Name
Farm/Group Name
Preferred Phone
Preferred Phone Type
Mobile
Home
Office
Email Address
Mailing Address
Street Address
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Unknown
Zip Code
County
If a dairy farmer, where do you ship your milk to?
FOOD PANTRY INFORMATION
Name
Estimated Number of People Served per Month
Contact Name
Contact Preferred Phone
Contact Email
Street Address
City
State
Zip Code
County
Is there a receiving dock?
Yes
No
I acknowledge that I have discussed this grant option with the Food Pantry, and they have agreed to receive the refrigerator provided by this grant
I further acknowledge that this grant will not be finalized until approved internally and the Food Pantry has completed a digital letter of agreement.
SCHOOL INFORMATION
District Name
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Unknown
Number of Students in District
Contact Name
Preferred Phone
Contact Email
Package Option
Package Option
Mobile Hallway Carts
Package Option
Smoothie Cart
Package Option
Latte Coffee Beverage Station
Package Option
Mobile Classroom Carts
I acknowledge that I have discussed this grant option with the School District, and they have agreed to receive one of the packages listed
I further acknowledge that this grant will not be finalized until approved by Midwest Dairy and the School District has completed a digital letter of agreement
PROJECT INFORMATION
Project Name
Project Start Date
What type of project is this?
Dairy in the Community
On-Farm
Gen Z Focus (Ages 13-25)
Project End Date - (Date Cannot Exceed 12/31/2024)
Project Location(s)
Estimated Number of Consumers Reached
Will the project be shared on social media?
Yes
No
Unsure
Provide a description (5-7 sentences) of your project and describe how your project will use the Undeniably Dairy brand and sustainability messaging that dairy is good for people, the planet, and our communities. Be sure to include how your project will target Gen Z (ages 13-25 years old) and or consumers removed from agriculture. Applications will be evaluated based on information provided and alignment with identified eligibility requirements.
Project Description
GRANT INFORMATION
Total Project Costs
Funding Amount Requested (up to $5,000)
All applicants are required to submit a W-9 form to Midwest Dairy for payment using our secure site.
If the name or business name on the W9 does not match the Check Payable To information below, the review process for your grant will be delayed.
If the address information on the W9 does not match the Mailed To information below, the review process for your grant will be delayed.
If Funding is Awarded:
Check Payable To
Mailed To: (Name, Street Address, City, State, Zip Code)
I certify that I have reviewed the eligibility requirements and are in good legal standing to apply for and use these funds. I also understand that IRS guidelines define grants as taxable income so an IRS Form 1099 will be mailed if the grant exceeds the IRS threshold for reporting
I further acknowledge that failure to meet the usage and/or reporting requirements could compromise our ability to request future funds.
ORGANIZED DAIRY GROUPS INFORMATION
President/Chair (this person will receive future Midwest Dairy notifications):
Name
Street Address
City
State / Province / Region
Zip Code
Phone
Email
Vice-President/Vice-Chair:
Name
Street Address
City
State / Province / Region
Zip Code
Phone
Email
Secretary
Name
Street Address
City
State / Province / Region
Zip Code
Phone
Email
Treasurer
Name
Street Address
City
State / Province / Region
Zip Code
Phone
Email
Princess Coordinator *If non-applicable enter N/A in the fields below
Name
Street Address
City
State / Province / Region
Zip Code
Phone
(If you do not have a Princess Coordinator, please add your email address to this field)
Email
List Additional Members (Name and Email): *If non-applicable enter N/A in the field below
Names and Emails
Attach a file
Generate a new image
Play the audio code
Enter the code from the image
Print Application before Submitting
Download W9
