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