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|[pic] |District 5550 Grants Committee |

| |District Project Grant Application |

TERMS AND CONDITIONS

1. Clubs in District 5550 must use this application form and attach additional pages as necessary;

2. Incomplete forms will be returned to the primary contact with a brief explanation;

3. Grant applications may be submitted for international or local projects;

4. Applications must be received by April 15. The following criteria will apply;

a. One application per club for their own project (no pooling with other clubs in the district is allowed;

b. The Minimum DDF Grant is $250.00 and the Maximum grant is $1,500. All grants must be matched with club funds on a 1:1 basis;

c. No disaster relief contributions, travel costs, or contributions to projects of other clubs will be considered;

d. Evaluation criteria will give preference to projects showing sustainability and directed to one or more of the six areas of focus. The evaluation criteria are posted on the website titled District Project Grant Application Scorecard;

e. A District Grant cannot be used as part of a Global Grant;

f. A District Block Grant will be submitted to TRF by May 31 each year. Decisions on the District Project Grant Applications will be announced to the clubs at that time but projects cannot proceed until TRF approval is received.

g. Any remaining funds will be distributed to applicants meeting the above criteria on a first come/first served basis

5. The Grants Committee may adjust funding limits during the year depending on the demand.

Application Form

1. Project Participation

a. Name of Rotary Club:      

b. Club Mailing Address      

c. Amount of District Project Grant Application being applied for:      

d. Location of Project:      

e. Total Cost of Project:      

f. What is the purpose of the Project, and how does it meet the need of the community?      

2. Project Description:

a. Provide a brief description of what the project entails:      

b. What will be provided by the grant?:      

c. Who are the beneficiaries?:      

d. How was the need identified?:      

e. Describe how this project is sustainable:      

f. Will there be ongoing costs to this project?       If yes, how will these ongoing costs be paid?      

g. On an annual basis, how many individuals will benefit “directly” from the grant proceeds (If the benefit is a “one time” benefit please indicate how many individuals will benefit from this “one time grant”):      

3. Areas of Focus:

Which area(s) of focus does the grant cover (please indicate with an “X” – more than 1 can be chosen):

a. Basic Education and Literacy:      

b. Disease Prevention & Treatment:      

c. Maternal and Child Health:      

d. Water & Sanitation:      

e. Peace and Conflict Prevention/Resolution:      

f. Economic and Community Development:      

4. Rotary Benefits:

a. Describe how the Project will make Rotary more visible:      

b. How will the community benefit?:      

5. Member Involvement:

a. Describe how your club members will be involved in the project:      

b. What percentage of the club membership will be involved in the Project?:      

6. Project Committee: A committee of at least two Rotarians must be established to oversee the project for the project duration, even if the project continues into another Rotary year.

|Primary Contact: |Secondary Contact: |

|Name:       |Name:       |

|E-mail:       |E-Mail       |

|Address:       |Address:       |

|Postal Code:       |Postal Code:       |

|Tel. Res.       |Tel. Res.       |

|Tel. Bus.       |Tel. Bus.       |

|Fax No.:       |Fax No.:       |

7. Cooperating Organization: (if the Project involves a cooperating organization).

a. Name of the Organization:      

b. Attach a letter of participation from that organization that specifically states its responsibilities, how it will interact with Rotarians in the project, and the organization’s agreement to cooperate in any financial review of activities connected to the project.

8. Project Budget: Include an itemized budget for the project on the page that follows or upload an Excel Spreadsheet (see footnote 1).

9. Reports: The Rotary Club receiving the Rotary District 5550 District Project Grant has the obligation of providing a report to the Rotary District 5550 Project Grants subcommittee within 2 months of the date of completion of the project or two years from the date the funds are received by the district, whichever is earlier. These reports will be filed using the reporting forms provided for this purpose and the club will provide receipts for any expenditures over $75 US.

10. Reimbursement: I/We understand that the funds will be sent to our club shortly after the funds are received from TRF

Applicant:

When the application form has been completed including the budget below[1], save it as a file in your computer. Next, e-mail it to Wayne Claypool, Chair District Project Grants Sub-Committee at: wclaypool@. After it has been successfully submitted, an email will be sent to the president of your club for his/her approval.

Budget:

|Date |Description |Amount |

|      |      |      |

|      |      |      |

|      |      |      |

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|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

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|      |      |      |

|      |      |      |

|      |Total Budget |$      |

Approvals Record – For Committee use only

Received Date____________________ Approval Date___________________________

District Project Grants Chair ____________________________________________________

District Grant Committee Chair ____________________________________________________

District Rotary Foundation Chair ____________________________________________________

THE SECTION BELOW IS AN EXCERPT FROM Terms and Conditions for Rotary Foundation District Grants and Global Grants (Effective 1 July 2013)

CLUBS ARE ENCOURAGED TO REVIEW THE TERMS AND CONDITIONS IN DETAIL PRIOR TO SUBMISSION OF THE DISTRICT PROJECT GRANT APPLICATION For Approval

III. Restrictions

Grants cannot be used to unfairly discriminate against any group; promote a particular political

or religious viewpoint; support purely religious functions; support activities that involve

abortion or that are undertaken solely for sex determination; fund the purchase of arms or

ammunition; support Rotary Youth Exchange, RYLA, Rotary Friendship Exchange, Rotaract, or

Interact; or serve as a new contribution to the Foundation or another Rotary Foundation grant.

In addition, grants cannot fund:

1. Continuous or excessive support of any one beneficiary, entity, or community

2. Establishment of a foundation, permanent trust, or long‐term interest‐bearing account.

Grant funds can be used to establish a microcredit fund if the sponsors comply with the

requirements detailed in section X.

3. Purchase of land or buildings

4. New construction of any structure in which individuals live, work, or engage in any

gainful activity, such as buildings (schools, homes/low‐cost shelters, and hospitals),

containers, and mobile homes, or of structures in which individuals carry out

manufacturing or processing activities. Additions to existing structures are acceptable.

5. Fundraising activities

6. Expenses related to Rotary events such as district conferences, conventions, institutes,

anniversary celebrations, or entertainment activities

7. Public relations initiatives not directly related to a humanitarian or educational activity

8. Project signage in excess of $500

9. Operating, administrative, or indirect program expenses of another organization

10. Unrestricted cash donations to a beneficiary or cooperating organization

11. Travel for staff of a cooperating organization involved in a humanitarian project

12. Global grant humanitarian projects that consist solely of individual travel expenses

13. Activities and expenses already in progress or completed

14. Activities primarily implemented by an organization other than Rotary

15. Transportation of vaccines by hand over national borders

16. Travel to National Immunization Days (NIDs)

17. Immunizations that consist solely of the polio vaccine

18. International travel for youth under the age of 18, unless accompanied by their parents

or guardians

19. Study at a Rotary Peace Center partner university in the same or similar academic

program as those pursued by Rotary Peace Fellows

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