ORU Individual Application | Comanche Electric Cooperative

Name and age of applicant

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Numbers

Phone Numbers
	Phone Numbers	Item weight

more items

E-mail

CECA Account Number

Does this account serve your permanent residence?

Yes

Name and age of spouse

Name, age and relation of others living at this address:

Employer, phone number and supervisor of applicant:

Employer, phone number and supervisor of spouse:

Are any other members in household employed?

Yes

If yes, please list employer, phone, and supervisor:

List service agencies you have contacted for assistance

Is individual receiving any other form of assistance or aid?

Yes

If yes, please list:

List monthly expenses:

Donation amount requested

Specific use of funds

Have you previously received funding from Operation Round-Up?

Yes

If yes, how much?

Name and phone number of three individuals or organizations familiar with your situation:

Attach any supporting statements or documentation to this application

One file only.
20 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.

I agree to the terms of service.