Tiffin Rotary Foundation Grant Application

Organization Name*

NameContact Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Nonprofit Status:*

501(c)3Other (please explain below)

If selected, to whom should the check be written?*

Address IF other than primary address listed above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Requested Amount*

When are funds needed?*

Date

Please tell us about your organization, including your mission statement:*

For what purpose do you plan to use this grant funding (include when and where): *

Please provide a detailed budget or breakdown of costs and how these funds will be applied.*

How do your organization, and this request, tie into the areas of Rotary Focus (Disease Prevention and Treatment, Peace and Conflict Resolution, Clean Water and Sanitation, Maternal and Child Health, Basic Education and Literacy, Economic and Community Development, Supporting the Environment)?*

How will this funding impact our community (include number of people to be impacted and any demographic information that you may have):*

Are you requesting additional or matching funds from any other community partners? If yes, please explain:*

Is there anything else you would like us to know when considering your application?

Please upload any photographs or drawings that will illustrate your project or help us better understand your grant request.

All grant applications must be submitted by the 28th of each month to be considered at the next regularly scheduled meeting of the Tiffin Rotary Club Foundation Board. If selected for funding, you will be asked to complete a follow-up report within six months of receipt of check.

For questions about this application or Tiffin Rotary Foundation funding, please contact Mark Somodi at msomodi@ptsrehab.com.