Community Grants - Application

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ROTARY CLUB OF POINT WEST SACRAMENTO

BENEVOLENT GIVING COMMITTEE
Click here for a Portable Transfer Document (pdf) version

APPLICATION FOR GRANT

Date:___________________________                     Amount of Request______________________

Name of Organization____________________________________________________________________

Payee_________________________________________________________________________

Address_____________________________________Phone _____________Fax______________

Name & Title of Contact Person____________________________________________________________

Day Phone_________________Evening Phone___________________Fax____________________

Describe (briefly 100 words/less) the purpose and activities of your program/organization. (Mission Statement):

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

State the Services, Program or specific Purposes for the requested funds:__________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Is this a new program or service?__________Is this an expansion of an existing program?___________

How will you continue the programs activities service after this funding?________________________

___________________________________________________________________________________

Please provide an exact breakdown on how the requested funds will be used:_____________________

___________________________________________________________________________________

___________________________________________________________________________________

Will the grant from Point West Rotary be publicly recognized?_________If so How?_______________

___________________________________________________________________________________

Which Point West Rotarian, if any, have you spoken with regarding this application?                                      

Mail all materials to PWR-BGC c/o 4001 Winding Creek Road, Sacramento, CA   95864

Additional Required Information to be submitted with the request.

• Last Annual Report
• List of Board of Directors & Organization
• Current Budget, including sources of funding
• Copy of IRS 501(c) 3 approval & tax exempt number (indicate ID# here:                                        )
• Copy of previous years IRS form 990
• Copy of last annual audit, including any findings or recommendations
• Copy of Franchise Tax Board (FTB) exempt authorization
• Copy of organization’s literature