Positive Change Request Form
Email address *
Organization name *
Your answer
Contact name *
Your answer
Address *
Your answer
Phone number *
Your answer
Website address (if any)
Your answer
Is this a registered 501c3 non-profit? *
Please provide your organization’s mission statement and a summary of your organization *
Your answer
For what program or purpose are you requesting a donation? *
Your answer
How does your organization and/or this program connect to at least one of Mississippi Market’s four strategic focuses (Local & sustainable agriculture, local hunger initiatives, nutrition education, or environmental sustainability) *
Your answer
How will the funds be used? *
Your answer
How will Mississippi Market be recognized? *
Your answer
Positive Change recipients collect donations from one calendar month. Is there an ideal time of year or particular month for which you are seeking funds? *
Your answer
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