Donation Request Form

Individual Requesting Donation
*First Name	Click or tap here to enter text.	*Last Name	Click or tap here to enter text.
*email	Click or tap here to enter text.
*Telephone	Click or tap here to enter text.	Cell Phone	Click or tap here to enter text.
*Mailing Address	Click or tap here to enter text.
*Status	Who is the requestor?
☐Tri-Cities Sunrise Rotary Club Member?
☐Other Rotary Club Member? Club Name: Click or tap here to enter text.
☐Donation Recipient?
☐Community Member? Community Name: Click or tap here to enter text.
☐Other? Click or tap here to enter text.
What is your relationship to the donation recipient? Click or tap here to enter text.
Recipient Information

For Whom is the donation request? *

☐ A high school or college student

☐ A 501 C(3) nonprofit organization

☐ A citizen in our local community

☐ A group or community based organization

☐ Other Describe: Click or tap here to enter text.

What is the mission of your organization, group, or the individual applying?*

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How will the Donation be Used?

What is the name, project or type of event for which the donation will be used?*

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What is the goal of the event or purpose for the donation?*

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What is the goal of the event or purpose for the donation?*

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What is the desired amount of funds you are requesting?*

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If applicable, what is the date by which the donation is required?*

Please allow at least 30 days for a decision to be made by our Trustees and Board of Directors.

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For what purpose will the donation be used? (be specific)*

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Have you previously received a donation from the Tri-Cities Sunrise Rotary Club?

☐ Yes ☐ No If yes, When? Click or tap here to enter text.
What was the purpose or use of the previous donation?

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If you donation request is approved, where should the funds be distributed?*

Payee Name: Click or tap here to enter text.

Payee Address: Click or tap here to enter text.

Payee Telephone: Click or tap here to enter text.

Special Directions: Click or tap here to enter text.

The Tri-Cities Sunrise Rotary Club is committed to strengthening the health, social, cultural and education fabric of our communities. Each member is committed to the Rotary philosophy of “Service Above Self.” With this in mind, please provide us with a summary of how this donation (if approved) fits into our philosophy.*

Click or tap here to enter text.

Would a member of your organization be willing to offer a short presentation to our Club during a regular Club meeting (scheduled on Fridays at 07:00)?

☐ Yes

☐ No

Would members of your organization be willing to volunteer during one of our community benefit or fundraising activities (See3Slam, Water Follies, Duck Race, etc.)?

☐ Yes

☐ No

The Tri-Cities Sunrise Rotary Club would like to thank you for completing this donation request form. A member of the Trustees or Board of Directors will be contacting you soon regarding this request.

To submit the request, please mail the completed form to:

Donation Request

Tri-Cities Sunrise Rotary Club

PO Box 2652

Pasco, WA 99302-2652

Or, submit the completed form via email to:

TCRotaryDonations@gmail.com