Kommunity Kids

Name of NDFU youth member:*

First Last

Address:*

Street Address Address Line 2 City State ZIP Code

Phone number:*

E-mail address:*

Name of county:*

Name of organization or activity requesting funds (proper name the check should be made out to):*

Name of mentor:*

Example: EPIC coach, county board member, parent, teacher, coach.

Mentor's phone number:*

Mentor's e-mail address:*

Amount requested:*

Item to purchase:*

Please describe where the NDFU logo will be located on the purchased item:*

Name of the vendor the item will be purchased from:*

Vendor e-mail address:*

This is required to send the NDFU logo electronically for placement on the item.

Why is a donation to this organization or activity important?*

Include the impact of the organization on the community or activity and other reasoning.