EmailMe Form - Erin Rotary Donation Request

Your Organization

Contact Name *

First Last

Title/Position *

Organization Name *

Email Address *

Contact Telephone *

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Organizational Structure *

Registered Charity

Not for Profit Organization

Individual

Other

Registered Charity Number

Main source of funding

What is your Organization’s Mission and Mandate? *

Your Project

Title of the Project *

Project Timeline *

Why is this project/program needed in our community? (Maximum 100 words)

Description / Details of the Project (Maximum 100 words)

What are the desired outcomes and who will benefit? (Maximum 100 words)

How will the success of the project/program be measured? (Maximum 100 words)

Project Budget

Expenses *

Operating
Capital
Total Expenses
Revenue
Net

*Note: quotes /estimates required for all capital items and professional services.

Amount Requested *

Date Needed

MM / DD / YYYY

Have you received funds from the Rotary Club of Erin in the past 5 years? If yes, please list dates and amounts.

Do you have other sources of funding secured or pending for this project/program? If yes, what organizations and amounts?

Volunteer Opportunities

Rotary is a service organization. Please describe any ongoing volunteer opportunities and/or short-term projects we could help you with.

Promotion

How will you share the news of receiving the funds from the Rotary Club of Erin

Is there someone willing to do a presentation to our club?

Yes

No

Terms

Successful proposals are required to complete and submit a Project Evaluation Form within three months of the completion of the project.

Signature

Clear

I am authorized to sign this application on behalf of my organization, and authorize the Rotary Club of Erin to obtain any information required with relation to this application. I hereby certify that the information contained in this application is true and correct.