Application For District Grant 2017-18
This form is to be used to apply for a Rotary District Grant (DG). Applications must be submitted to the District Foundation Grants Subcommittee no later than May 15, 2017
Section 1 - Club and Committee Information
Please note: PROJECT COMMITTEE must have at least THREE members
Club Name and Number *
Is this a CORRECTED SUBMISSION - of a grant already submitted this year? *
Club President (2016-2017) *
Your answer
District Grant Committee Chair Name *
(must be a member of the club making the application)
Your answer
District Grant Committee Chair Street Address *
Your answer
District Grant Committee Chair City *
Your answer
District Grant Committee Chair State *
Your answer
District Grant Committee Chair Zip *
Your answer
District Grant Committee Chair Phone Number *
Your answer
District Grant Committee Chair e-mail address *
A copy of this form will be e-mailed to this address
Your answer
District Grant Committee Chair - Club Position *
District Grant Committee Member Name One *
Your answer
District Grant Committee Member One Street Address *
Your answer
District Grant Committee Member One City *
Your answer
District Grant Committee Member One State *
Your answer
District Grant Committee Member One Zip *
Your answer
District Grant Committee Member One Phone Number *
Your answer
District Grant Committee Member One e-mail address *
Your answer
District Grant Committee Member Two Name *
Your answer
District Grant Committee Member Two Street Address *
Your answer
District Grant Committee Member Two City *
Your answer
District Grant Committee Member Two State *
Your answer
District Grant Committee Member Two Zip *
Your answer
District Grant Committee Member Two Phone Number *
Your answer
District Grant Committee Member Two e-mail address *
Your answer
Section 2 - Project Description
Project Title *
Your answer
Describe the project in sufficient detail for proper evaluation *
Your answer
How will it meet the needs of the community being addressed by the project? *
Your answer
Estimated project completion date *
MM
/
DD
/
YYYY
Section 3 - Project Budget
Include a complete itemized budget for the project
Costs *
Include item names, names of suppliers and estimated cost per item
Your answer
What is your Total Project Cost? *
Your answer
What is the amount that your club be donating to the project? *
Your answer
What is the total amount of the District Grant you are requesting? *
Your answer
Please describe any other source of funding for the project
Your answer
Section 4 - Conditions
1. District Grants support service activities or humanitarian projects in which clubs or the District wish to support.

2. Each project must:
a. Adhere to the grant policies which govern all Rotary grant programs.
b. Respect the wishes of the receiving community.
c. Focus on ONLY ONE specific activity.

3. District Grants require the direct involvement of Rotarians by:
a. Assessing community needs and developing a project plan.
b. Establishing a committee of at least 3 Rotarians to oversee the project.
c. Overseeing the expenditure of grant funds.
d. Involve Rotarians in the implementation of the project.
e. Provide evidence of community involvement and ownership.
f. Organize meetings with local service providers, officials, and/or recipients of the benefits of the project.
g. Promoting of the project in local media.

4. Recipients of District Grants shall report as necessary and shall submit a final report by April 30th or upon the completion of the project and the expenditure of the grant funds.

5. As District Grant Chair of this Rotary Club I agree to all of the above conditions and certify that the Rotary Club President (2016-'17) has approved this Grant Application and is aware of the conditions set forth herein.

By checking this box you, the Club District Grant Chair, agrees to all conditions set forth in the dialogue above *
Required
Club District Grant Chair e-signature *
Your answer
Section 5 - Reports
1. A final report is required by April 30th 2018or upon the completion of the project.
2. The report is to be made on the District Grant / Final Report Form, found on the District Website www.rotarydistrict7500.org
Section 6 - Submission Instructions
A copy of this application will be e-mailed to your clubs Grant Committee Chair, as well as the District Grant Committee Chair.

Once you submit your application - you can make correcrtions. After hitting SUBMIT you will be brought to a Thank You page, you can click on EDIT YOUR RESPONSE, to make any changes. You must hit SUBMIT again to change your responses.

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