Grant Application

The Rotary Club of West Chester/Liberty is asking that applicants for charitable grants make a formal application for funds for the 2017-2018 Rotary fiscal year (July 1, 2017 – June 30, 2018). You may find out more information about our Club at our website, www.westchesterrotary.org. Our Board will choose the grant recipients from those who submit Grant Applications. For grants in the fiscal year, please submit your Grant Application by November 30, 2017. The Board will make its decision by December 15, 2017 and you will be notified shortly thereafter.

Please send this completed application to Peyton Gravely. If you have any questions, please telephone Peyton at (276) 358-0128.

Section One

Date of Application

organization information

Applicant Organization (Full Legal Name)
Doing Business As
Previous Name, if changed
IRS letter date
Tax Exempt ID # (EIN)
Name of Executive Director
Name of Fiscal Sponsor (if applicable)

Contact Information

Proposal Contact Name
Title
Phone
Fax
E-mail
Street Address
City
State
Zipcode
Organization Website
Mailing Address (if different from street address)

Organization financial information

Organization’s Budgeted Expenses for Current Year (give fiscal year end mm/dd/yy)
Endowment Size (market value as of fiscal year mm/dd/yy)
Organization’s Major Funding Sources by percentage
(e.g., United Way, local community foundation, county board of health, etc.)

Organization’s affiliation

Request Data

Program/Project Title
Total Budget for this Program/Project
Amount of this request
Grant Duration (e.g., one-year, two-year, etc.)
Anticipated Project Start Date
Community/Counties served by this Program/Project
Total Number of people to be served during grant period
Brief demographic description of population served by this Program/Project

Signatures

Signature of Executive Director
Signature of Board President

In general, the following narratives, which include Sections Two through Four, should not exceed the space supplied, or if you decide to use additional sheets, please do not exceed 3 pages for Sections Two, Three and Four.

Section two – organizational background

1) Brief summary of organization’s history and statement of organization’s mission< br />

2) Brief description of current programs/projects and activities

3) Brief description of population and geographic region (community/county) served by this organization

section three – statement of need

1) What is the problem, challenge or need that is unaddressed or unmet? Or what is the community benefit that this program or project will impart?

2) What is the research, statistic(s) or evidence that shows this need or benefit exists?

section four – program / project description

1) Description of program/project, including:

a) Summary description of overall program/project to be funded under this grant

b) Brief description of goals and objectives for program/project

c) Timetable for implementation and duration of program/project

2) Brief description of how grant funds will be used.

section FIVE – required attachments

1) IRS letter of determination for 501(c) (3) status.
Choose File:

2) Names and professional affiliations of your organization’s board members.
Choose File: