<p> Rotary Club of Mandarin LOCAL CHARITY REQUEST APPLICATION</p><p>Legal Name of Organization:</p><p>Address:</p><p>Phone Number:</p><p>Email:</p><p>Contact Person/Title:</p><p>Mission of Organization:</p><p>Tax ID #: Year Founded:</p><p>SPECIFIC Reason for Request:</p><p>List Organization Primary Source of Funding:</p><p>Amount Requested:</p><p>Total Project Budget and Timeline:</p><p>Does Applicant primarily serve clients in the Mandarin area?</p><p>Names of Involved Mandarin Rotarians:</p><p>As Applicant’s Authorized Official, I hereby certify that the information contained in this application is true and correct, and, should funds be awarded to Applicant, such Applicant will adhere to and be bound by all the terms and conditions outlined in the Application and Guidelines.</p><p>Signature of Authorized Official Date</p><p>Printed Name of Authorized Official</p>