Community Empowerment Program Grant Application
Please complete the form and submit by clicking the "Submit Form" button below. Please attach the required Organization Description, Project Narrative and Budget Summary using the document upload tool at the end of the form. Detailed application instructions and requirements can be found on the website at www.medinaec.org/grant.

If you have any questions please visit MedinaEC.org, email MyCoop@MedinaEC.org or call 1-866-MEC-ELEC (632-3532).

Fields with * are required fields.

Applicant Information
*Legal Name of Organization:
Doing Business As (if applicable):
*Mailing Address:
*City:
*State:
*Zip Code:
*Physical Address:
*City:
*State:
*Zip Code:
*Tax ID Number:
Company Phone Number:
Website:
*Contact Name:
*Contact Phone Number:
*Email Address:
*Counties Served (select all that apply):
Atascosa Brooks Dimmit Duval Edwards Frio
Jim Hogg Kinney LaSalle McMullen Medina Real
Starr Uvalde Webb Zapata Zavala   
Project Information
Grants of $2,500 or more require a minimum 50 percent match of the total project cost.
*Amount Requested:
*Total Project Cost:
*Title of Project:
*Anticipated Completion Date:    (MM/DD/YYYY)
Will the requested funds enable the completion of the overall project?
*Will funds enable completion?:
Are any in-kind services being offered for this project?
*In-kind services being offered?:
If in-kind services are being offered, please provide contact name, describe the service and state the dollar value of service.:
Does the requesting organization have a reserve/operating fund?
*Reserve/operating fund?:
If yes, how much money is in the reserve fund?
Amount in the reserve fund?:
If the reserve fund is not being used, please explain why.:
*Physical Address of Project:
*City:
*State:
*Zip Code:
*Name of Property Owner:
Please upload the following required documents that need to be submitted with the completed application: Organization Description, Project Narrative, and Budget Summary. Please see website for detailed information and requirements for each. Please be clear and concise and do not send information that was not requested.
*Organization Description:
*Project Narrative:
*Budget Summary:
This application must be signed by the CEO or administrator of the organization requesting the grant.
To the best of my knowledge and belief, all information in this application is true and correct.

Click here to draw your signature.

With your mouse, draw your signature. Then click Finish.


*Date:
*Name:
*Title:





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