ROTARY CLUB OF PARK CITIES FOUNDATION GRANT APPLICATION
I. Contact Information
Organization Name
Key Contact
First Name
Last Name
Key Contact Title
Key Contact eMail Address
example@example.com
Key Contact Phone
-
Area Code
Phone Number
Executive Director or President (if different from Key Contact)
First Name
Last Name
Executive Director or President eMail
example@example.com
Executive Director Phone
-
Area Code
Phone Number
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Physical Address (if different from mailing)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
II. Organization Information
1. Date Founded
-
Month
-
Day
Year
Date
2. Tax ID Number
3. Legal Name
4. DBA
5. Number of Full-time Staff
6. Number of Part-time Staff
7. Current Year's Operating Budget
8. Is your organization required to file a Form 990/990-EZ?
Yes
No
If yes, what is the date of your most recent Form 990/990-EZ?
-
Month
-
Day
Year
Date
9. Does your organization have a regular independent audit?
Yes
No
If yes, what is the date of your most recent audit?
-
Month
-
Day
Year
Date
III. Grant Request Information
1. Date of request
-
Month
-
Day
Year
Date
2. Date payment needed
-
Month
-
Day
Year
Date
3. Title of Grant Request
4. Amount of request
5. Total project budget?
Does the purpose of your grant fall under:
*
Please Select
Health Wellness
Tackling Hunger
Promoting Leadership
7. Type of Funding - Please check all that apply
Seed/Pilot Funding
Project/Program Suport
Capital/Equipment
Other
8. Geographic area(s) served
9. Demographic breakdown of population served (socio economic status, ethnicity, gender, age)
10. Organizations with whom you collaborate and how you do so:
11. Have you received any prior grants from the RCPC Foundation
Yes
No
If so, when?
-
Month
-
Day
Year
Date
Please list any contacts you have in the Rotary Club of Park Cities
IV. Grant Details
1. Provide the unduplicated number to be served annually by this proposal, if applicable
*
2. What are the goals of your project?
*
0/1000
3. How will the grant request be used to further your goals?
*
0/500
4. What is the timeline of the project? Use bullet points and chronological order.
*
0/500
5. Describe plans to support the proposal under the term of this grant.
*
0/500
6. How will you measure the outcome of this project?
*
0/500
Attachments
The following documents should be uploaded as part of this application
Organization's governing body, including professional, business or community affiliations
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Detailed project budget (including income and expense)
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Agency budget for the current and previous year including budget to actuals
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Current financial statement (including a statement of assets and liabilities
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Most recent Form 990 or Form 990-EZ (if applicable)
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Signed audited financial statement (if applicable) for most recent two years
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A copy of your 501(c)(3) IRS determination letter (if applicable)
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Supplemental supporting documentation, such as pictures, a letter to the board, etc.
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Submit your completed application by clicking here
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