District 6630 Grants Committee

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					                District 6630 Grants Committee
                                 Grant Inquiry Form
Date of Submission to Grants Committee: __________________
If you know, please circle type of grant required:

 District Simplified Grant (for local projects)            Matching Grant (for international projects)



                       Rotary Club Information (Please provide at least 2 contacts)
Rotary Club of:                                    Club No:
Contact Person:                                    Email:
Phone: Office:                Cell:                 Home:                     Fax:
Mailing Address:


Contact Person 2:                                  Email:
Phone: Office:                Cell:                 Home:                     Fax:
Mailing Address:


                       Rotary Partnership Club Information (if applicable)
Rotary Club of:                                    Club No:
Contact Person:                                    Email:
Mailing Address:

Contact Person 2:                                  Email:
Phone: Office:                Cell:                 Home:                     Fax:
Mailing Address:


                                      Project/Program Summary
Give a brief description of your Project:




Who will this project/program serve?
(special populations, geographic area, community focus, organizational focus, etc.)
                                                   Working Budget
Please provide an estimate of the total project cost:



Proposed/available funding from Rotary club(s):




Funding requested for DSG match (minimum $500, maximum $2500, DSG will match up to 1:1 with club
funds up to the $2500 maximum):




          Funding for Matching Grants will be discussed with your grant liaison.
Comments/Questions:




                             COLLABORATIONS AND other SUPPORT
Please tell us if you are collaborating with any other organizations (or local clubs).



SEND THIS FORM TO:                                                Carbon Copy to:
District 6630 Grants Committee                                    District 6630 Grants Committee
Application Coordinator:                                          Chair:

Jim Eldridge                                                      David Skrzynski

16125 Lucky Bell Lane                                             690 Wyleswood Drive
Newbury, Ohio 44065                                               Berea, Ohio 44017
                                                                  440-915-4995
(H) 440-564-9281
(O) 440-7-8-2828                                                  dnb9899@aol.com
(F) 440-708-2835

Email: jeldri1786@aol.com

Thank you! District 6630 Grants Committee will review your inquiry and make a determination within a few weeks of
receipt, at which time you will either be requested to submit additional information or a full proposal, or be informed that the
Foundation is not able to fund your request.
2012-2013

				
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