Georgetown-Millsboro Rotary Club

Community Grants Application

Please type or print clearly.  Submit this application in accordance to the grant guidelines.

Organization ___________________________________________________________________

Grant Writer’s Name and Title ____________________________________________________

Street/Road ____________________________________________________________________

Town_____________________________________________ State _______ Zip ____________

Day Phone    ________________________________  Fax  ______________________________

Email _________________________________ Web Site _______________________________

Name, Phone, and Email of Executive Director or Program Coordinator

__________________________________________________________

__________________________________________________________

_________________________________________________________

Organization’s IRS Tax ID #_______________________________________________

Funding Request

Amount being requested                                 $________________

Project’s approximate total budget                 $________________

Mission Statement

(Briefly describe the organization’s mission statement and goals)

History

(Briefly describe the organization’s history, including start date and major accomplishments)

Project or Grant Description

(Describe specifically how Georgetown-Millsboro Rotary funds will be used and the organization’s or project’s objectives. Include details about the targeted population and geographic area(s) being served.  If applicable, indicate if funding from other sources has been obtained or requested.

Action Plan

(Describe the specific steps and timeline to accomplish your objectives and the people and/or other organization involved)

Evaluation

(Describe how the outcome of the project will be measured and/or what will be considered a successful result.  How will this grant provide a meaningful benefit to our community?)

Attachments

• Testimonials or newspaper articles about the organization
• Project/Program expense report with anticipated income sources
• Organization’s most recent IRS tax-exempt letter
• List of board members with contact information

My signature indicates I certify the information in this application and attachments are accurate and complete to the best of my knowledge.

Name and Title __________________________________________ Date ____/_____/____