<p> The Rotary Club of Powhatan, VA APPLICATION FOR CHARITY FUNDS</p><p>This application must be completed and sent to: Chairman, Charity Committee, Rotary Club of Powhatan, P.O. Box 327, Powhatan, VA 23139. </p><p>Name and Address of Requesting Organization: </p><p>Purpose and Mission of Requesting Organization: </p><p>Amount Requested: $ . Amount of the Goal $______</p><p>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? </p><p>Specifically, who will be served as a result of these funds? How many people will be affected? </p><p>.</p><p>Please specify IRS 501 (c) (3) status. Is a copy of IRS 990 available upon request? Tax ID#: </p><p>Signed by: Title: Referring Rotarian: Date: </p>