Microsoft



District 5610 Pop Up Covid-19 Grant ApplicationDue date is May 10, 2020. Funds will be dispersed May 15, 2020. Send completed application to: Covid-19 RID 5610 Grant Team℅ Ina Winter, DG kristine.ina.winter@Grant requirements:Must address needs generated by the Covid-19 pandemic, including economic impacts.Must be local - either your community or a nearby community without a Rotary Club.It is ok to give the funds to a local organization addressing the needs you identify.It is ok to partner with a local organization to leverage your grant funds.Funds must be used by August 1, 2020. Maximum award is $2,000.The grant project or program should enhance the public image of your Rotary Club.Grant report is due within 14 days following project completion. Report form is appended to this application.1Rotary Club Name:2Contact Person - name, email and phone #, and where to mail the check:Contact person: __________________________________________email: __________________Phone: __________________________Mailing Address: _________________________________________ _________________________________________3Amount Requested: $ ___________________________________________4Brief Description of Project:Include how many people will benefit from this grant (estimate is fine).5Who are the beneficiaries? Check all that apply:___Healthcare workers ___Other essential workers___Children/Youth ___Elders ___Families___Small community businesses ___Vulnerable Communities: _____________________________________Other: ___________________________________________________6What need will be addressed?Check all that apply:___Food ___Healthcare ___Childcare___Mental health ___Economic hardship relief___Restoring community resilience ___Raising spirits___Other: ___________________________________________7Can you accept less than the funding requested and still have a viable project?___Yes ___NoIf yes, what is the minimum amount you could use for this project? $ __________________________________________8What is your plan to enhance the public image of your club and Rotary in general:___Local media ___Poster/flyer/placarding___Word of mouth ___Online platform___Other: ______________________________________________9Club Officer must sign agreeing that the funds will be used as set forth herein:10Club Officer: You can print - fill out - scan and send to Ina or you can fill out on computer and send to Ina through that officer certifying the application.District 5610 Pop Up Covid-19 Grant ReportReport must be submitted within 14 days of project completion. Send this report along with the original application to: Covid-19 RID5610 Grant Committee℅ Ina Winter, DGkristine.ina.winter@1Rotary Club Name:2Contact Person (if different than on the application) - name, email, phone:3Did you use the entire grant amount awarded? ___Yes ___NoPlease return unused grant funds.If no, how much was NOT used: $_________________Send to: Nicole Rawden, District Administrator P.O. Box 605 Volga, SD 57071Note on check: “Pop up fund return”4Did the scope of your project change? ___Yes ___NoIf so, how?5How many people benefited from this project? Best estimate is ok:6Did you have a partner organization?___Yes ___No If so, who are they and what did they contribute?7How were you able to advance the public image of Rotary and your club in your community? Send examples if available such as newspaper clippings, etc.8What lessons were learned? Things to replicate and things that could be better:9As of the date of this report, are there continuing needs in your community as a result of the Covid-19 pandemic and associated economic impact?___Yes ___No What are they:10What comments do you have about this grant opportunity and the grant process?11We prefer that you keep your answers short and succinct, but if you need more space, please use a separate page and submit along with this report. Signature of the Club Officer below to certify that funds were used as reported and the report is accurate.12Club Officer: ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download