C-K Rotary Community Service Project Grant Application Form

C-K Rotary Community Service Project Grant

Application Form
Application Deadline: midnight October 15, 2022
I. About your organization
Organization Name *
Type of Organization *

Not-for-profit Registered charity
Registration number, if a registered charity:
Mailing Address *

Street Address

Street Address Line 2

City Province

Zip Code Country
What is your organization's mandate or purpose? (max 50 words) *

0/50
Organization's Web Address, if applicable
When was your organization started? *
What demographic does your organization serve in the Kingston community? PLEASE BE SPECIFIC (max 50 words) *

0/50
Current board of directors (name, position) *
Does your organization or group have an EXISTING or PAST connection with ANY Rotary Club? If so, please describe. (max 100 words) *

0/100
Does your organization receive any Federal, Provincial, or Municipal funding? If so, please indicate source, amount, and purpose. (max 50 words) *

0/50
Organization's Financial Statement (upload file) *

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II. Contact Person for this Grant
Contact Person's Name *

First Name Last Name
Title or Position *
Contact Person's Email *
example@example.com
Phone Number *

Area Code Phone Number
Lead person for this project *
Lead person's email *
example@example.com
Qualifications of person(s) in your organization attached to this project (max 100 words) *

0/100
III. Project Information

Project must be completed within one year of funding.
Project title *
Start Date *

Month Day Year
Date
End Date *

Month Day Year
Date
TOTAL FUNDS REQUESTED *
Project Special Events

if applicable
Event 1
Event 1 Date

Month Day Year
Date
Event 2
Event 2 Date

Month Day Year
Date
Event 3
Event 3 Date

Month Day Year
Date
Main Field of Interest (choose one that most closely matches your project) *

Peace and Conflict Resolution Disease Prevention and Treatment Providing clean water, sanitation, and hygiene Maternal and Child Health Basic Education and Literacy Economic and Community Development Preserving the environment
Type of project (choose one or two that most closely match your project) *

Pilot New Expansion of existing project Purchase of equipment Training Educational
IV. Project Purpose
What needs are you addressing and how were they assessed? (max 50 words) *

0/50
Who will benefit most from this project? (max 50 words) *

0/50
How do you justify this particular project at this time? (max 50 words) *

0/50
V. Project Description
Please describe your project and it’s GOALS. (max 150 words) *

0/150
Please describe the sequential steps, and their respective timelines, in carrying out your project. (max 100 words) *

0/100
What people, materials, and services are required? (max 100 words) *

0/100
Please list any partners that will participate in this project, if applicable. (e.g., other Rotary/Rotoract Clubs, community non-profits/registered charities, other.) (max 50 words) *

0/50
VI. Project Impact
What results are you expecting? (max 100 words) *

0/100
Who will benefit most from your project? How? (max 50 words) *

0/50
How many people will benefit (directly and indirectly) from your project? (max 50 words) *

0/50
How will you evaluate/measure the success of your project? (max 100 words) *

0/100
If successful, how might will build on this project in the future? *

0/50
VII. Project Budget and Financing
Please provide the Budget for your entire project, even if you are requesting funds for only a specific part of the project. (upload spreadsheet) *

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Please provide a breakdown of your Budget for your specific needs and costs. (e.g., category, unit cost, subtotal per category, Total Cost) (upload spreadsheet or file) *

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If only partial funding is granted, where will the funds be applied? (max 50 words) *

0/50
Have you received Rotary grants before? If so, specify granting club, year(s), amount, and purpose (max 50 words) *

0/50
Have you received any funding for this project SO FAR? If yes, please indicate source(s) and amounts. (max 50 words) *

0/50
Are you seeking funding for this project from other sources? If so, please indicate which ones and amount requested. (max 50 words) *

0/50
VIII. Connections with the Rotary Club of Cataraqui-Kingston
How does your project fit with Rotary’s values and priorities. (Refer to Guidelines) (max 50 words) *

0/50
How might you encourage Rotarians or other community members to participate in your project? (max 50 words)? *

0/50
How might our club and its members continue to work with you after your project is completed (max 50 words)? *

0/50
How will CK Rotary be recognized for its role in this project? (max 50 words)? *

0/50
How did you hear about our Community Service Project Grants? *
IX. Required Acknowledgments
Please acknowlege that you are aware that the final step before acceptance may require a Zoom presentation or interview to discuss the project *

Yes
Please acknowlede that a final follow up report, along with a detailed financial statement, will be required not later than 12 months following receipt of the grant. Please include all relevant documents (e.g., copies of receipts, purchase orders, etc.) Photos would be appreciated! *

Yes
Support documents (optional), maximum 2 pages, including letters of support and images; combine as a single pdf file.

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X. Submission
Signature *

Clear
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C-K Rotary Community Service Project Grant

Application Deadline: midnight October 15, 2022

I. About your organization

II. Contact Person for this Grant

III. Project Information

Project Special Events

IV. Project Purpose

V. Project Description

VI. Project Impact

VII. Project Budget and Financing

VIII. Connections with the Rotary Club of Cataraqui-Kingston

IX. Required Acknowledgments

X. Submission