Please complete the online application at DreamfieldsFoods.com

Contact Information
* First Name
* Telephone
Middle Name
* Address
* Last Name
* City
* Title
* State
* Email Address
* Zip/Postal Code
Please complete the online application at
DreamfieldsFoods.com/50States50Plates
Organization Information
* Organization Legal Name
* Organization Mailing Zip/Postal Code
Organization AKA Name
* Organization Email Address
* Organization Mailing Address
* Organization Telephone
* Organization Mailing City
* Organization Website Address
Organization Mailing State
* Organization Mission
Your organization's background, history and/or
mission statement
Please complete the online application at
DreamfieldsFoods.com/50States50Plates
Proposal Information
* Project Title
* Please specifically state/explain
how Dreamfields’ funding will be used
in the proposed program/project.
* Project Date
Month
Day
Year
* Request Amount
* Project Budget
* What approaches will you use to
communicate Dreamfields’ brand and
its role as your partner in this work?
Please list the different ways in which our support
will be known and to what groups.
* Please name any organization/
* Number of estimated
individual being honored at this event
participants in your program
Please enter N/A if no honors being given.
Please complete the online application at
DreamfieldsFoods.com/50States50Plates
Organization Certifications
* Is this grant being requested by, or at the behest of, a government official?
Yes No
* Will this grant be used to provide any benefit, including, but not limited
Yes No
* Does Dreamfields or any of its employees or directors exercise control over
Yes No
* Do you have any branch offices, operations, or representation in U.S.
Yes No
* Do any members of your Board, staff or organization have any indictments,
Yes No
* Does your organization have fewer than three board members?
Yes No
* Does your organization have at least one separate financial or accounting
Yes No
* Does your organization have "conflict of interest" policy and procedures?
Yes No
* I certify to the following grant agreement clauses.
I certify
* I certify that this organization complies with all applicable laws, including
I certify
to, meals, entertainment, or travel, to a government official? (Note that
"meals" might include a group setting such as a gala dinner.)
your Organization?
sanctioned countries or any relationship, including but not limited to
financial, with any entity or individual designated by the U.S. as a prohibited
party or Specially Designated National?
convictions or conflicts of interest?
person or function?
those relating to tax-exempt status, charitable registration and reporting, and
anti-discrimination laws.
Please complete the online application at
DreamfieldsFoods.com/50States50Plates