The Rotary Club of Powhatan, VA

The Rotary Club of Powhatan, VA APPLICATION FOR CHARITY FUNDS

This application must be completed and sent to: Chairman, Charity Committee, Rotary Club of Powhatan, P.O. Box 327, Powhatan, VA 23139.

Name and Address of Requesting Organization:

Purpose and Mission of Requesting Organization:

Amount Requested: $ . Amount of the Goal $______

Has anyone from the organization spoken, or scheduled to speak, at a regular meeting of the club? . Specifically, how will the requested funds impact your organization’s operations?

Specifically, who will be served as a result of these funds? How many people will be affected?

Please specify IRS 501 (c) (3) status. Is a copy of IRS 990 available upon request? Tax ID#:

Signed by: Title: Referring Rotarian: Date: