Foundation Grant Application

This is a request for funds over $1,000 from the Racine Founders Club Rotary Foundation, Inc., which will be reviewed by the board of directors. Do not apply if your groups does not desire to have its complete operation reviewed on this process.

Organization Name

Address

City/Town

State/Province

ZIP/Postal Code

Name of President

Name of Director

Current list of Board of Directors

Number of Paid Employees

Number of Volunteers

Contact Person

Name

Title

Telephone

Funding

Does your agency have a federal tax-exempt status?

Attach a copy of the Internal Revenue Service ruling or determination letter, if not attached, please explain.

One file only.
2 MB limit.
Allowed types: jpg png pdf doc docx.

Lack of Internal Revenue Service ruling or determination letter explanation

Date Established

Total Annual Budget of the Organization:

Total Financial Support Received Last Fiscal Year:

Total Financial Support Received Last Fiscal Year From Memberships:

Total Financial Support Received Last Fiscal Year From Foundations:

Total Financial Support Received Last Fiscal Year From United Way:

Total Financial Support Received Last Fiscal Year From Government Programs:

Are your financial records subject to an audit?

If yes, is a copy of the audit available upon request?

Fund Raising Activities:

Contributions:

Total Financial Support Received Last Fiscal Year From Individuals:

Total Financial Support Received Last Fiscal Year From Corporations:

List previous grant applications to Racine Founders Club Rotary Foundation, Inc. during the last five years.

Date of Application

Project Title

Amount Requested

Amount Approved

How did you become aware of the Racine Founders Club Rotary Foundation, Inc. and its grant program?

Project Information

Type of project:

Total cost of the project

Funds requested

The Racine Founders Club Rotary Foundation, Inc. mission establishes several broad categories of community need. Please indicate by checking the category, which in your view is appropriate for your grant application.

Project Start Date:

Project End Date:

Describe the project for which you are seeking funds. Please include specific objectives of the project.

How was need determined and how will the project respond to this need?

Indicate your organization’s special qualifications to address these needs.

Describe your project evaluation plan. Be very specific about who will evaluate it, the expected completion date for the objectives, and the criteria for judging success.

List other sources of support being approached. If necessary, attach list.

Source

Amount Requested

Current Status

Attach List Here

One file only.
2 MB limit.
Allowed types: jpg png pdf doc docx.

If the project is ongoing, please identify future pending sources for succeeding years or the duration of the project.

Certification

Within 30 days following completion of the project, we will submit a summary report including an accounting of all expenditures.
We will provide additional project or organization information if so requested.
This grant application has been authorized by the organization’s governing body or chief executive.

Name

Title

Required Attachments

Current financial statement (balance sheet and statement of operations)

One file only.
2 MB limit.
Allowed types: jpg png pdf doc docx.

Detailed agency budget – current year

One file only.
2 MB limit.
Allowed types: jpg png bmp pdf doc docx.

Detailed project budget

One file only.
2 MB limit.
Allowed types: jpg png pdf doc docx.

Copy of the Internal Revenue Services ruling or determination letters of status under Section 501 © (3) and 509 (a) of the Internal Revenue Code.

One file only.
2 MB limit.
Allowed types: jpg png pdf doc docx.