2025 Emergency Response Equipment - Regional Collaboration Grant Application

Emergency Response Equipment - Regional Collaboration Grant Application

Fields marked with an * are required.
The mission of Compeer Financial’s Emergency Response Equipment – Regional Collaboration Grant Program is to bring specialized equipment to rural volunteer fire, rescue or ambulance departments located in or providing direct services to our 144 county service area.

Grants are offered for two or more collaborating departments serving adjacent jurisdictions. Only one department should serve as the fiscal agent to receive the grant funds, if awarded, on behalf of all collaborating departments. The funding request should be for a single piece of specialized emergency response equipment.
- Cost must be detailed in the request, and if cost exceeds the grant amount, applicant must indicate how the remainder will be funded.
- Funds are not for deficits already incurred.
- If awarded, all funds must be used by the end of the current calendar year.
- Requests for vehicles, buildings, and training and certification (unrelated to this equipment grant) are not eligible.
- Law enforcement agencies are not eligible for this grant.
Review complete program criteria here.

Submission deadline: 11:59PM August 31, 2025

Notes on using Jotform:

SAVE: Use the 'Save' button at the end of the application any time you need to save your progress and return later. The Jotform® platform will prompt you to either sign up with email, log in, or Skip Create an Account. If you do not have a Jotform® account or do not want to create one, choose Skip Create an Account. You will then be able to email yourself a link to access the saved application later. You may need to check your spam or junk folder for the email.

SUBMIT: After clicking 'Submit,' a Thank You page will appear confirming your application has been submitted. You will also receive an email with the completed application for your records. You may need to check your spam or junk folder for the email.
Name of Organization/Fiscal Agent*
Upload W9 for Legal Entity*

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Contact Name*

First NameLast Name
Contact Title*
Contact Phone Number*

Area CodePhone Number
Contact Email*
Mailing Address for Legal Entity*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Collaborating Department Information

Fiscal Agent (collaborating department #1): this should be the department listed above as the Fiscal Agent.
Type of Department*
Number of Active Members in Department*
Characterize Response Area (check all that apply)*

RuralTownshipCountySmall Town (under 5,000 population)City (over 5,000 population)
List County(ies) served where this department has primary service response.*
Collaborating Department:
Name of Department #2*
Type of Department #2*
Number of Active Members in Department #2*
Characterize Response Area Department #2 (check all that apply)*

RuralTownshipCountySmall Town (under 5,000 population)City (over 5,000 population)
List County(ies) served where department #2 has primary service response.*
Are there additional collaborating departments?*

YesNo
Name of Department #3
Type of Department #3*
Number of Active Members in Department #3*
Characterize Response Area Department #3 (check all that apply)*

RuralTownshipCountySmall Town (under 5,000 population)City (over 5,000 population)
List County(ies) served where department #3 has primary service response.*
Are there additional collaborating departments?*

YesNo
Name of Department #4
Type of Department #4*
Number of Active Members in Department #4*
Characterize Response Area Department #4 (check all that apply)*

RuralTownshipCountySmall Town (under 5,000 population)City (over 5,000 population)
List County(ies) served where department #4 has primary service response.*
Are there additional collaborating departments?*

YesNo
If there are more than 4 collaborating departments, enter the remaining department name(s):*

0/50
Do you have permission from all departments listed above to submit this request on their behalf?*

YesNo
Total Primary Response Area in square miles for all collaborating departments*
Total Resident Population of Primary Response Area for all collaborating departments*
Detail the equipment needed, purpose of the equipment, and how the departments will collaborate its use.*

0/100
Detail the cost of the equipment.*

0/100
Total funds requested (maximum $10,000)*
Is the cost of the equipment greater than the requested grant amount?*

YesNo
Detail how the remaining cost will be funded.*
Detail how this equipment will benefit the collaborating departments and their communities. Detail past and/or present need for this equipment.*

0/100
How did you learn about this grant program? (Select one that is the best fit)*

Email from Compeer FinancialReferred by a Compeer Financial team memberNotice in Compeer Financial Publication – Cultivate Magazine, Flyer, Etc.Social Media post by Compeer Financial, including posts sharedReferred by Past Grant Recipient/ Community PartnerHeard on the Radio/Podcast or read in a publication (outside of Compeer)Internet SearchOther
Name of Team Member
Additional comments or information to support the request.

0/100
Optional Photo Submission

Photos help bring your story to life. Upload photos that showcase the impact of your organization in your community. (Examples include group photos, facilities or equipment in use, people/team members using equipment, schematic drawings, sketch, etc.) If you prefer, you can provide your Facebook or Instagram handle and give us permission to select photos from your public profile. The submitted photos are for promotional purposes only and will not be used during grant review. If selected as a recipient, the images may be used in grant promotional materials.
Click 'Browse Files' to upload photo(s).

Browse Files

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Facebook and/or Instagram handle
For valuable consideration, the receipt and sufficiency of which is acknowledged, I grant Compeer Financial, ACA; Compeer Financial, FLCA; and Compeer Financial, PCA (collectively, “Compeer”), their directors, employees, agents, assigns, licensees, and representatives, the absolute and irrevocable right and permission to copyright, use, publish, republish, distribute and exhibit the submitted image in any form, that I have created and submitted to Compeer or uploaded to any social media platform or of me or in which I may appear, in conjunction with my name if they so choose, in all forms, advertising, and media and in any other manner for any lawful purpose, including but not limited to, for purposes of publication, commerce, and trade and in connection with or as part of Compeer’s trade name, or any goods, services, package, container, label, trademark, logo, trade dress, or advertising, promotional, marketing, or sales materials. Additionally, I waive any right to inspect or approve the finished product, or any materials or copy that may be used in connection with such photographs, video, digital images or sound recordings. By submitting or uploading an image, I represent and warrant to Compeer that content I submit is original content that does not violate any third party’s copyrights and that I have obtained permission from all identifiable people featured in the original content.
Click to Acknowledge
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