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Rotary District 7230 District Grant Proposal This form is to be used by clubs to submit a proposal for a District Grant from District Designated Funds (DDF) for a local community project. Grant funding is a minimum of $500 up to $2,500, matched $1 for $1 with club contributions. One grant request accepted per club. The proposal must be submitted by January 20, 2017. Projects that are repeat projects or ongoing (year to year) will not be accepted for review. Only new projects will be considered. Results of the application review will be announced on february 15, 2017.

Applicant Club

________________________________________________________________________

Project Title

_______________________________________________________________________

Project Area(s) of Focus: (Check all that

Peace & Conflict Prevention/Resolution: ___ Disease Prevention and Treatment: ___ Water and Sanitation: ___ Maternal and Child Health: ___ Basic Education and Literacy: ___ Economic & Community Development: ___

apply)

Project Description (briefly list goals and activities)

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Community Need

________________________________________________________________________ ________________________________________________________________________

Beneficiaries

Who?____________________________________________ How many?_____________

Project Duration

Est. Start (Mo./Yr.):____________________ Est. End (Mo./Yr.):________________________ Rotary Club:______________________________________________________________ Other Organization:________________________________________________________ List all contributions which total to project budget Amount

Project Partners

Club contribution___________________________________________ $_____________ Project Budget

Partner contribution_________________________________________ $_____________ DDF grant sought___________________________________________$_____________ _________________________________Total Project Budget________$_____________ List all items to be purchased Amount _________________________________________________________ $_____________ _________________________________________________________ $_____________

Project Cost

_________________________________________________________ $_____________ _____________________________________Total Project Cost______ $_____________ Note: Project Cost must equal Project Budget

Publicity Plan Primary Project Contact Submission Date

_______________________________________________________________________ Rtn._______________________________, Club Position: _________________________ Email Address:_______________________________ Tel:_________________________ ________________________________________________________________________

Completed form should be submitted via email in doc format by the primary project contact to Rtn. Sandy Wolstein, sewolstein@optonline.net, Tel: (914)-218-1258 (cell). DGSC Jim Lanfranchi, Jlanfranchi@websterbank.com will be reviewing and approving the application The email from the primary project contact will be accepted as an electronic signature of the form. The club president must also be copied on the email.

Rev Date: 12/15/2016


Districtgrantproposalform(d 7230) 201617