Charitable Grant Application

Applications accepted from

January 1 to March 31

Charitable Grant Application

We are pleased to offer limited funding each year to support special projects of local charities that serve children, young people and their families. These projects should focus on health, education, child safety and family welfare. If possible, we prefer to give to projects that can be completely funded with our contribution or where the club contribution completes an already partially funded project.

We require organizations that receive grants to provide documentation through receipts of how the funds were used and if the proposed project was completed. Failure to submit this documentation by the deadline will exclude the organization from consideration. Lastly, new projects must be submitted each year and cannot be repeated. If you have any questions, please contact Susan Imhoff, Committee Chair at 912-222-5686.

Name *

First

Last

Organization Name

Email *

Phone

Organization’s Mission: Please give a brief history of the organization, including the official mission statement or organizational statement.

Project/Program Description: Please describe the specific program/project for which grant funds are being requested. Is this an existing program or a new program?

Funding Requested $

Cost of Total Project $

How does this proposal meet the objectives of your mission? Please describe the need for the services to be provided. How were the needs determined?

Please describe the target population whom your organization’s project will serve and the geographic area covered. Please include an estimate of the number served.

List your three largest sources of income/ funding during the last year.

List any government grants and/or United Way contributions. Enter 'None' or 'N/A' if none received.

If you received a grant from the St. Simons Rotary Club last year, please report on the use of grant funds in accomplishing your project plan. Enter 'None' or 'N/A' if no grant was received last year.

Signature

By submitting this form I am indicating the following: - I am a representative of the above 501 (c) (3) organization and am authorized to submit this information. - All information is accurate and true.

Your Title