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. Box1741, 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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