Edited Grant Application 1 22 11

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					Rotary District 5030 Family Homelessness Grant
Please read the cover sheet that will assist you in the selection of projects that may be funded and other
FAQ’s. If you have further questions you can contact one of the committee members listed or your
Assistant Governor for assistance.

The Rotary Club of:

Club President’s signature:

Contact Person that has written this application:

This project for ending family homelessness will fall into one of two catagories, please identify which.

                Preventative                                       Immediate Need

A description of your project and information about the partnering agency or service provider:

Please attach additional pages about your project if needed.

How many families will be assisted by this project?

Is there a hands on component for your club members? (This is not a requirement)

What is the time frame of this project? Start date & completion?

Who is the contact person at the agency/provider and their contact information?

Please provide a signed letter of agreement from any agency /provider that outlines your project with
them outlining the project and detailed budget. Who should the check be made out to; mailed to the
provider or mail the check to your Rotary club (provide a mailing address).

This is a Rotary District 5030 Family Homelessness “matching” grant. We will match your clubs funding
from $2,500.00 up to $5,000.00. What dollar amount will your club be funding that we will be
matching? The total project cost will be double the amount your club provides; i.e. $3,000.00 +
$3,000.00 = $6,000.00

To qualify for these funds you and your club are agreeing to the following:

    1. Have a Rotary club program (speaker) to discuss some area of family homelessness issues in the
       area your club is located (city/county) within 9 months of today. Date planned:
    2. Ask your partnering agency to add your club to their web site as a donor or project partner. Seek
       ways to promote your project through PR and provide any PR pictures or releases to our Rotary
       District 5030 Family Homelessness Committee member:
    3. Keep good financial records and provide any financial review if the funding flows through your
       club with your final report. We recommend a Rotarian with a financial background.
    4. To have your committee and any members of your club participate in a short survey before you
       start your project and after you have completed it. This would be anonymous, Survey Monkey
       and would be used as part of a study on Family Homelessness in our region.
    5. Prepare a final report no later than 11 months after receiving your funding OR 2 months after
       the end of the project; whichever is sooner. Some projects may have a long time frame; others
       may be completed in a short amount of time. The report should include the following bullet

               How many families were actually assisted?
               What was the cost per family or individual for your project?
               Was the project implemented as you expected?
               Were you satisfied with the outcome of this project?
               Will your club continue to engage in efforts to end family homelessness next year?
               Final thoughts and insights

Included with your 2 page form:         Any additional pages of project description
                                        A signed agreement with any service provider (partner)
                                        Contact information for the Rotarian that wrote this application
                                        Do you have all the signatures on this application?

I understand the responsibilities in accepting these funds and my club has the ability to follow through
with the requirements listed above:
                                        Rotarian responsible for this project

We will contact you with any questions and be in touch with the contact person regarding “next steps”
information in about 2 weeks. Your Rotary 5030 Family Homelessness Committee thanks you for
applying for this grant and making a difference in your community.


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