2019-2020 District 5420 Rotary Service Impact Report
Utah Rotary Clubs: This Service Impact Report will be most easily completed by reviewing and tallying (using the Excel Sum Function) service #s and $$ from the Excel document sent September 2019. However, if your club did not use this form, please report your service to the best of your recollection.

There are 3 parts of this Report:
1. Select your Featured project and report that information. Select the service project with the most impact, or tally numbers and dollars from multiple projects within the same service focus area for your club.
2. List the service project titles and brief descriptions for all the service your club has contributed, in addition to your Featured project or multiple projects related to the same service focus area.
3. Report all numbers and dollars for your club's service this Rotary Year, including your Featured project or Service focus area. If you have used the Excel form distributed in September 2019, you can simply sum the relevant columns.

If you need help, contact your Assistant Governor, or DG John Hanrahan's Chief of Staff Judy Zone.
Club Name:
Your answer
Name of Rotarian completing this Report:
Your answer
Email of Rotarian completing this Report:
Your answer
Cell # of Rotarian completing this Report:
Your answer
Title of your club's Featured project or Service focus area for multiple projects:
Examples: Refugee service, Service with the homeless, Utah Reads, Coats for Kids Car Show, Tree planting
Your answer
If you are reporting a Service focus area representing multiple service projects accomplished by your club this Rotary Year, report the number of projects in all:
Your answer
Number of lives impacted:
Please report the number of people who benefited directly from the Featured project/Service focus area. A single number is required as input. We understand the number may be an estimate.
Your answer
Total number of Featured project/Service focus area volunteers:
How many people, including Rotary volunteers, worked on the project? One person who volunteers twice or more on the project should be counted as just one volunteer. If you are using the Excel record provided by the District, this is one time the Sum function should not be used to double count club members.
Your answer
Total number of Featured project/Service focus area service hours
Please record the number of total hours from volunteers. Be sure to include hours spent planning and organizing the project.
Your answer
Total CLUB dollars donated for Featured project/Service focus area:
Your answer
Total other funds donated:
Please list any funds donated by other sources, including the District, RI, or funds donated by club members if not included with club funds above. Clubs with a foundation separate from the club should list funds donated by the foundation for the project here.
Your answer
In-kind donations:
Describe the in-kind donation, for instance "winter coats" or "socks" or whatever may have been donated in-kind for the project.
Your answer
Value of in-kind donations:
Please estimate the value of in-kind donations.
Your answer
Upload one or more photos for your Featured project or Service focus area.
You may upload one or more photos here: Please rename your photo as the name of your club, followed by 1, 2 or 3 if you have multiple photos. For example: Logan1, Logan2. We can only use high-resolution photos, preferably the resolution they come straight from the camera. On a phone this would be 'actual size.'
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