2015 Luxury Raffle Grant Application Form

2015 Luxury Raffle Grant Application Form
Application Directions
 Please print and use this format or incorporate this format into your own file as
you prepare the application.
 Completed application should reach Ann Wilmoth by June 26, 2015 by mail, fax
(724-397-9003) or email ([email protected])
 Mailing Address: 646 Hastings Road, Marion Center, PA 15759
Name of Requesting
Organization
Title of the Project for
which Funds are Requested
Please note:
 Requests for funds must be restricted to a specific project of a charitable or not-for-profit
501(c)(3) organization.
 General operating expenses are not to be included in this request.
 Indiana Rotary requests that a representative from each selected organization attend the
2015 Luxury Raffle on November 7th. Each representative will be recognized during the
evening.
 Funds requested from Indiana Rotary under this program are intended to be used for
projects that benefit the Greater Indiana County, Pennsylvania Community.
Organization
Address/Location
Contact Person’s Name
Contact Person’s Title
Phone
Email
How is your organization
funded?
501(C)(3) Status
How did you learn about
this grant opportunity?
___yes ___no
Project Description
1. Briefly but clearly describe your project. What will be done; when and where will
the project activities take place? (Note: typical funding proposals include about one to
two page(s) of detail for this item). Please incorporate your narrative here or attach it
to the form.
2. What opportunities or services will this project provide to community members? Please
give at least two clear examples.
3. How many people in the Indiana County community will benefit from this project?
4. What are the expected long-term community impacts of the project? Please be very
specific.
5. If the project is to continue beyond one year, how will the requesting organization fund
the sustained project?
6. In addition to Indiana Rotary, will other cooperating organizations be involved in funding
this project? If so, be specific in how these organizations will be involved in the project.
Have other organizations been asked to fund this project, or is Indiana Rotary the sole
funding option for the project?
Project’s Budget Details
7. Your financial request
· What is the total cost of your project______________
· What is the total request from Indiana Rotary _____________
· What other funding do you expect to receive______________
. Attach a detailed budget.
How will you spend the funds requested from Indiana Rotary?
8 (a). Specify the cost of materials or equipment to be purchased. Attach a detailed cost
estimate or vendor’s quote for each major purchase you expect to support from this request.
8 (b). What contracted services will you need to complete your project? (Please keep in mind
that Indiana Rotary will not fund requests for wages or salaries for workers of the requesting
organization nor will it fund requests for operating funds.) Attach a detailed cost estimate or
vendor’s quote for any contracted services requested.
Signatures of officials of the requesting organization:
Organization’s
CEO or principal
board officer
EXACT TITLE
X_____________________ ______, 2015