D7390 District Club Grant Application

District 7390 District Club Grant Application
District Club Grant (DCG)Pre-Funded DCGMicro DCG
1. Project Description

Please describe the project, its location, its objectives, and how they will be attained. Note: The project cannot be started until the Grant Application is approved by the District Grants Committee.
Project Description
Estimated Start Date of Project:

MonthDayYear
Date
Estimated Completion Date of Project:

MonthDayYear
Date

2. Other Non-Rotary Organizations

If this project involves a cooperating organization, provide the name of the organization below. Attach a letter of participation from that organization that specifically states its responsibilities and how Rotarians will interact with the organization in the project. By signing this application, the Rotarian sponsors endorse the organization as reputable, responsible, registered with the project country, and acting within the laws of the project country.
Name of Organization:
Upload the letter of participation from the organization.

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3. Rotary Club in District 7390 Making the Application:

Name of the Club that will coordinate the principal funding for the project and that will assume responsibility for the project:
Club Applying for the DCG:*
Project Contacts:

Three Rotarians must be listed who will provide oversight and management of project funds for the entire duration of the project, even if it continues into another rotary year.
Primary Contact Name

First NameLast Name
Primary Contact Rotary Position/Title
Primary Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Primary Contact Email
example@example.com
Additional Contact Name

First NameLast Name
Additional Contact Position/Title
Additional Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Additional Contact Email
example@example.com

4. Membership:
How many members were in your Club last year?
5. Stewardship:
What was the amount of your Club's donations to The rotary Foundation Annual Fund during the past Rotary year?
6. Project Budget

Include a complete itemized budget for the entire project. Price quotes from the supplier and/or other cost documentation must be uploaded for each item valued at a total cumulative cost of $1,000 or more.

Project Budget

Rows	Name of Item	Cost
Item
Item
Item
Item
Item
Item
Total

Upload Supplier Estimates:

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7. Purchase of Equipment, Materials, or Supplies:
Who will own equipment, materials, or supplies? (Cannot be owned by a Rotary Club or Rotarian)
Who will be responsible for maintenance, operation, and/or storage costs of the equipment/supplies?
YesNo
8. Proposed Financing

Please list all financing and indicate cash and District Club Grant money being requested:

Financing Available

Rows	Amount
Name of Rotary Club (Primary Sponsor)
Other Rotary Club/District
Other Rotary Club/District
Other Rotary Club/District
Other Rotary Club/District
Additional Funding from other sources (if any)
Subtotal
Amount requested from District Club Grants (Up to the amount contributed by Rotary (s) or $2500 per Club)
Total

9. Publicity

How will the general public know that this is a Rotary-sponsored project? Please provide details, e.g., publicity in a newspaper, display of the Rotary wheel, etc....
Publicity
10. Report

The sponsoring club is required to complete and submit progress and final reports to the District Grants Committee. Please indicate the individual who will take primary responsibility for submitting these reports:
Name

First NameLast Name
Email
example@example.com
The Rotarian Belongs to the Rotary Club of:*

11. ACTIVE ROTARIAN PARTICIPATION AND AUTHORIZATION
Sponsorship Authorization
All Rotary clubs and Districts involved in this project are responsible to the District 7390 District Grants Committee and ultimately to The Rotary International Foundation for the conduct of the project and for reporting on it. The signature at the bottom of this page confirms that the sponsors understand and accept responsibility for the project. Sponsors may either sign this page or submit a separate letter of commitment.
Please list below the activities your club will undertake demonstrating the active involvement of Rotarians in this project.
All information contained in this application is true and accurate, to the best of our knowledge.This application meets all District Club Grant criteria as stated in District Club Grant (DCG) "Grant Training".The club has agreed to undertake this project as an activity of the club.This is the only district Grant supporting the project described herein.We understand and will comply with the required Rotarian activities and reporting requirements as stated in District Club Grant (DCG) "Grant Training".We agree that, should the project take more than six months to complete, interim reports will be submitted every six months from the time the grant is approved, and a final report will be provided no later than two months after the completion of the project.The club understands that it cannot give a donation to an 501c, to be matched as a DCG. Exception being the Club's own 501c Foundation where the invoices and checks of the Foundation must be filed with the final report.
Name

First NameLast Name
Signature

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Rotary Club of:*
Date

MonthDayYear
Date
12. AUTHORIZATION OF CLUB'S FUNDS
Complete the authorization for Club funds to be used for this project. Presidents of all Clubs contributing MUST sign an authorization.
Club President Name

First NameLast Name
Rotary Club of:*
Signature

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Date

MonthDayYear
Date
Amount Authorized $

District 7390 District Club Grant Application

1. Project Description

2. Other Non-Rotary Organizations

3. Rotary Club in District 7390 Making the Application:

Project Contacts:

4. Membership:

5. Stewardship:

6. Project Budget

7. Purchase of Equipment, Materials, or Supplies:

8. Proposed Financing

9. Publicity

10. Report

11. ACTIVE ROTARIAN PARTICIPATION AND AUTHORIZATION

12. AUTHORIZATION OF CLUB'S FUNDS

13. COMPLETION CHECKLIST