ROTARY CLUB OF HIGHLANDS
The Rotary Club of Highlands’ objective in awarding grants is to be involved in “startup”and/or new projects that applicants might be attempting. We would like to consider grants for one time purchases of equipment or funds for new projects that applicants could utilize on a one time basis.
Please fill out this application to be considered for a grant donation from the Rotary Club of Highlands.
This information will be used for the express purpose of evaluating and awarding a grant to your organization and will be held as private and confidential.
Please complete the following form and submit to: The Rotary Club of Highlands, P. O. Box 1741, Highlands, NC 28741
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Organization Name:____________________________________________________________________
501(c)3 organization? ___ Yes ___ No Fed. ID#: _______________ Pending:___________
Mailing address:___________________________________________________________________
Phone #:________________________________ Fax #:___________________________________
Org. Email:____________________________ Web Site:__________________________________
Contact Person:____________________________Title:___________________________________
Phone #:____________________________ Email:________________________________________
Amount of Funds Requested:___________________ Date Needed:________________________
Has the Rotary Club of Highlands contributed to your Org. before?___Yes Date:________
No:____
Has your Org. made a project presentation to the Rotary Club? ____Yes Date:________
No: ____
Would a representative of you Org. be willing to make a presentation to the Rotary Club?
____Yes.____No.
Please answer the following questions completely as possible. You may include additional information on separate pages if you need to.
What is the Mission of your organization?
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Describe the project/purchase for which the funds requested will be used?
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Describe the population that you hope to benefit from this project/purchase?
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How will you recognize The Rotary Club’s contribution to your project/purchase?
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Total Project/Purchase Budget:______________ Amt. Raised To Date: ____________________
What are your Org. plans to raise the balance of funds needed?
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NAME:____________________________________
SIGNATURE:________________________________
FOR ROTARY CLUB USE ONLY
Received:__________ Reviewed:__________ Amount:_________ Approved: ___Yes ___ No
Comments: ___________________________________________________________________________________
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