District 7120 District Simplified Grant

DISTRICT 7120 DISTRICT SIMPLIFIED GRANT APPLICATION FORM 2014-2015

Rotary District 7120 Club ______

Address ______

Name and Contact information for Person Responsible for Grant work______

Rotary District 7120 Clubs must use this form to apply for a Rotary 7120 District Simplified Grant and answer all the questions as outlined. If applicant chooses to re-type this application, the sequence of the grant questions must be followed. Submit grant to DSG Chairperson, Doris Marsh, no later than April 1st by sending an electronic copy to ([email protected]) and a hard copy to 2252 Gilbert Road, Dalton, NY 14836.

For the Rotary District 7120 2014-2015 year, District Rotary 7120 clubs are to note the following changes for DSG writing: a. Grants may be used for local projects, small international projects, and scholarships. b. Grants used for scholarships must include Rotary District 7120 in their name. c. Clubs may apply for two grants if one is a scholarship. d. In order to receive any grant, clubs must be qualified. Qualification includes signing a Club Memorandum of Understanding and having a minimum of two (2) members (preferably the president-elect and foundation chair) attend a grant management seminar. e. Submit Club MOU (Memorandum of Understanding) with addendum with your DSG application. f. Please note that all grant money will be disbursed upon receipt of the written final report which includes receipts for all purchases. g. While these grants do not need to be in an area of focus, they must meet the Mission of Rotary.

Revised 7/24/13 The mission of the Rotary Foundation of Rotary International is to enable Rotarians to advance world understanding, goodwill, and peace through the improvement of health, the support of education, and the alleviation of poverty.

A. PROJECT DESCRIPTION

1. What is the purpose of the project?

2. Provide a brief description of the project.

3. How will it meet the needs of the community?

4. How does this project meet the Mission of Rotary?

B. COOPERATING ORGANIZATIONS

List the cooperating organization(s), if any: 1. Name of organization #1______Name of Contact Person ______Telephone # ______Revised 7/24/13 E-mail address ______

Name of organization #2 ______Name of Contact Person ______Telephone # ______E-mail address ______

(Use another sheet, if you have more than 2 cooperating organizations.)

2. Attach a letter(s) of support/participation/acceptance from each cooperating organization that specifically states the organization’s responsibilities and how organization(s) will cooperate/work with Rotarians on this project.

C. PROJECT COMMITTTEE

A committee of at least two Rotarians must be established by the applicant to oversee the project for its duration, even if it continues into another Rotary year.

Primary Contact Secondary Contact Name ______Address ______E-mail ______

Telephone ______

D. PROJECT BUDGET

Attach an itemized budget for the entire project. Provide Pro forma invoices, supplier price quotes, and/or other cost documentation as applicable.

Revised 7/24/13 E. PURCHASE OF EQUIPMENT

Who will own equipment, maintain, operate, and secure items purchased with grant funds? Equipment cannot be owned by a Rotary Club or Rotarian.

F. PROPOSED FINANCING

Rotary Club Share $

DSG Requested $

Cooperating organization(s) $

TOTAL $

IMPORTANT: If the DSG Committee awards a partial (or reduced amount) of the funds requested, will your club still go forward and complete the project or do a revised version of your project? Yes____ No_____

G. AUTHORIZATION

By signing below, we are agreeing to the following

 All information contained in this application is true and accurate, to the best of our knowledge;  The application meets the Terms and Conditions of District Simplified Grant applications;  The club has agreed to undertake this project as an activity of the club.

Current President Current President-Elect

Name______

Signature______

Revised 7/24/13 Date______

H. REPORTS

Although both signatories above are ultimately responsible for completing progress and final reports, one should take the primary responsibility for submitting the reports to the District Simplified Grant Committee.

By signing below I accept primary reporting responsibility for the above project.

Name ______Signature______

Date______

I. DISTRICT APPROVAL

District 7120 Simplified Grant Committee has approved the above described Application for use of District Simplified Grant Funds on ______.

Attested by:

District Simplified Grant Committee Chairperson

Name ______Signature ______

Date______

J. MEMORANDUM OF UNDERSTANDING has been submitted to Chuck Turner, District Foundation Committee Grants Chair. Initial ______.

Revised 7/24/13 Revised 7/24/13