APPLICATION

The form will be used to assist the Club to assess your application. You should note that Rotary prefers grant applications which benefit the wider community, not just individuals or organisations and which meet Rotary’s humanitarian objectives (see www.rotary.org.au).

We may contact you to obtain further information or we may wish to meet with you to discuss further. If you need more information, or are unclear about what we need, contact the Secretary (details below).

Submitted by: (individual name)
Contact details: (address, email & contact number)
On behalf of: (name of organization if applicable)
Date submitted:
Project Title: (max15 words)
How has the need for this grant arisen? (max 400 words)	.
What will the grant achieve? (no more than 3-4 points)
Who will benefit from the grant? (include individuals, communities, organisations)
Have you secured any other funding or applied elsewhere? (if yes, please give details of the outcomes)

If you type into the Table cells above, they will expand as you add more words. You may go on to a second page which is OK, but no more than 2 pages total!

Budget

Proposed Schedule:	Start Date:	End Date:
How will the grant be spent?:	Item Description	Cost
(What do you need to buy to make the project happen, and what will the items cost?)	$
$
$
$
$
TOTAL (this is the amount you are asking Rotary for)	$

Add rows/lines to the Table above or use more space if you need to do so

Rotary to complete

Rotary Committee to manage:
Date received:
Committee Assessment: Do we need more information Does it meet Rotary’s criteria Does it seem likely that it will achieve its aims Who will benefit
Committee comments:
Committee recommendation to Board: