DISTRICT 6170 District Grant Application 2018-2019 Note: Please read the Project Criteria and Club Qualification on page 4 of this form to assure that your project qualifies for funding. Deadline for filing this application: July 31, 2018 (Received by Grants Chair, Bill DeVore) (Complete interactively, save, and return by e-mail; or print the form, complete manually, sign, scan, and return. There is also a.pdf version available.) e-mail to billd72032@yahoo.com; Or mail to: Bill DeVore; 940 Reynolds Ave, Conway, AR 72032; (501) 733-5778 Enter the Name of your Rotary Club Name the most recent project funded by a District Grant or District Simplified Grant: Year-> Describe the new proposed project, its locations, and its objectives: Select whether this project is a new project, repeat of a previously funded project ( not eligible), or a continuation of a previously funded project. Expected Start Expected Completion Area Of Focus: (Selecting an area of Focus for a district grant is not required, but is encouraged to familiarize our clubs with the overall areas that The Rotary Foundation emphasizes in its global assistance funding) Peace and Conflict Prevention/Resolution Disease Prevention & Treatment Water & Sanitation Maternal & Child Health Basic Education & Literacy Economic and Community Development
District Grant Application Page 2 of 5 Describe how the project will benefit the community and/or improve the lives of the group you hope to serve: Describe the non-financial participation by Rotarians in the project:
District Grant Application Page 3 of 5 Public Relations; How will the general public know this is a Rotary-sponsored project?: Cooperating Organizations: If the project involves a cooperating organization, please provide the name of the organization below and attach a letter of participation from that organization that specifically states its responsibilities and how Rotarians will interact with the organization in the project. By signing this application, the Rotarian sponsors endorse the organization as reputable, responsible, and acting within the laws of the United States. Provide two club contact names for this project: Primary Project Contact; who will provide oversight and management of project funds: Name Phone Rotary Title E-Mail Addr City State Zip Secondary Project Contact: Name Phone Rotary Title E-Mail Addr City State Zip Budget: Provide a detailed, intemized budget for the entire project. Supporting documentation for the development of this budget may be requested. Receipts MUST be presented with the final project report for ALL grant expenditures! Project Cost Item Description Amount 1. $ 2. 3. 4. 5. 6. Total Project Budget amount Less Amount to be paid from club funds (if any) Less Amount to be paid by other cooperating Organizations (if any) Net Amount of Grant Requested
District Grant Application Page 4 of 5 Project Criteria and Club Qualification: Appropriate Grant Implementation The use of funds from The Rotary Foundation must comply with the conditions for funding as stated in the RI publication Terms and Conditions for Rotary Foundation District Grants and Global Grants (https://my.rotary.org/en/document/terms-and-conditions-rotary-foundationdistrict-grants-and-global-grants) as found in My Rotary.org, including the following: 1. Promote active and personal participation of all Rotarians involved in the implementation of the project; 2. Not involve the establishment of a permanent foundation, trust, or permanent interest bearing account; 3. Not directly benefit a Rotarian, an employee of a club, district, or other Rotary entity, or a spouse, lineal descendant, or an ancestor of any living Rotarian or Rotary employee; 4. Not duplicate any existing TRF or other Rotary-sponsored program; 5. Exclude any liability to The Rotary Foundation or to Rotary International except for the amount of the grant; 6. Be consistent with the criteria, procedures, and policies of the Polio Plus program and the World Health Organization for projects involving vaccines and immunizations; 7. Not be used to reimburse clubs/districts for projects already undertaken and in progress, an existing project, activities primarily sponsored by a non-rotary organization, or for projects that are already accomplished; Club eligibility includes these criteria established by the District 6170 Foundation Committee: 1. Clubs must have contributed to The Rotary Foundation during the Rotary year preceding the award of the grant; 2. The Club s President-Elect must have attended the PETS assembly; 3. At least one club member must attend the full district assembly s Grant Management Seminar; 4. Club President and President-elect must have signed and returned TRF s Memorandum of Understanding no later than the submission of the district grant application; 5. The proposed project must be in keeping with the mission of Rotary; 6. Club must have a positive history of record keeping in any previous grants; 7. Club must be current on dues to the district and to Rotary International; 8. The proposed project, including all reports, must be able to be completed by June 30, 2017; 9. Projects must be new projects not repeats of projects previously funded by District Grants or District Simplified Grants; 10. Clubs may submit only one (1) application per club; joint submissions involving more than one Rotary Club will count as one submission for each of the participating clubs.
District Grant Application Page 5 of 5 Club Affirmation: As president of the Rotary Club of I hereby affirm that the club s board has voted to undertake this project as an activity of the club and that the club s officers and directors have read, understood, and agreed to the terms and conditions of receiving a District Grant, available at www.rotary.org. In consideration of receipt of these grant monies, we further agree to abide by the terms and conditions of this grant application and to report on grant progress six months from the date of approval and at the completion of the project on approved forms as prescribed by the Rotary District 6170 Grants Committee. Failure to file complete and timely reports will necessitate the repayment of all grant funds received. By signing this application I confirm that the Rotary Club of, and I understand and accept this responsibility. I also affirm that all information in this application is true and accurate. Club President s Name: Club President s Signature: Reviews and approvals (for District use only): Final Amount of Grant Approved for this project $ District 6170 District Grants Committee Chair signature District 6170 Rotary Foundation Chair signature District 6170 Rotary District Governor signature