District Grant (DG) Application 2023-24          Rotary District 6540
Rotarians: Use this form to request a District Grant
See Rotary GrantsTerms & Conditions on www.rotary6540.org or on Rotary International website for eligibility and program restrictions.

APPLICATIONS WILL BE ACCEPTED STARTING JANUARY 1, 2023.  APPLICATIONS ARE DUE
NO LATER THAN MARCH 31, 2023. This is an e-application and will be submitted online.
Preliminary Approval notifications expected APRIL 30, 2023. Final Approval from RI expected June
30, 2023. You will be notified when we have received final approval from RI.

Your project cannot start until we have final approval from RI and not before July 1, 2023.
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Email *
I have read the District and RI Guidelines on the district website and attest that the grant that our club is submitting meets the above.   *
If your not sure please contact District 6540 District Grants Chair: Sharon Kish, skish33@gmail.com 219-508-1516 to discuss before submitting this application
PRIMARY ROTARY CLUB
Project Contacts: Two Rotarians must be listed who will provide oversight and management of the project funds for the entire duration of the project, even if the project continues into another Rotary year. One of them will normally be the applicant please enter the Name email address and phone number of the second contact below
Primary Contact Name (first and last) *
Select Your Club Name *
Club Mailing Address
Primary Contact Phone Number *
Secondary Contact Name
 *
Secondary Contact Email
 *
Secondary Contact Phone Number
 *
1a.Project Title *
 1b.Project Description *
Please describe the project, its location, its objectives, and its implementation. The project
cannot be started until July 1, 2023 following the final approval of the District Grant Application
by the Rotary International Foundation.  Summarize the proposed project.
1c. Project Beneficiary *
Give a brief description of the primary beneficiary (the recipient of goods and/or services).
1d. Community Needs *
Describe your community needs and how this project will address those needs.
1c. Which of the Areas of Focus does this project serve? *
1d. ESTIMATED PROJECT START DATE:                  ESTIMATED PROJECT COMPLETION DATE: *
Projects must not be started prior to July 1, 2023. Projects must be completed and reported by June 24, 2024.
2. PARTICIPATING ORGANIZATIONS
2a.
If the project involves a cooperating organization (an organization that is directly involved in the implementation of the project, offering technical expertise and project coordination), provide the name of the organization below.  Emailing a letter of participation from that organization that specifically states its responsibilities and how Rotarians will interact with the organization in the project is helpful but not required.
2b.
How will the Rotary Club and all partners communicate and work together to implement this project? Please
provide specific examples of activities and responsibilities
3. PROJECT BUDGET and PROPOSED FINANCING
Complete template request for the project and indicate currency used (if other than $US). Email form to District Grant Chair after submitting this form. Price quotes from the supplier and/or other cost documentation for significant expenditures must be sent upon request. ie. Items to be purchased-Name of Supplier-Cost

List all financing sources, amounts, and currency, as well as the District Simplified Grant money being requested. Note that the sponsor Rotary club is expected to participate financially. Email  authorization of funds from additional financing sources with your completed grant template form.  Funding Sources and Expected Amount (Identify currency) must equal project budget on form.

Download the grant finance template form on the District 6540 Website at the link below and email it once complete to
https://portal.clubrunner.ca/50034/Documents/en-ca/a847eddd-3f32-45a2-8303-6ce3e78e3348/1/

Submit a voided club check along with the completed grant finance template 
4. PURCHASE OF EQUIPMENT, MATERIALS, OR SUPPLIES *
Who will own equipment, materials, or supplies after project completion? (cannot be owned by a Rotary club or Rotarian)Who will be responsible for maintenance, operating, and/or storage costs of the equipment/supplies?If equipment/supplies will be shipped, have arrangements been made? If the project is international, have arrangements been made for customs clearance? Please identify and describe.
*
5.CONFLICT OF INTEREST*
5.1 Ensuring integrity in Rotary Foundation grants requires that everyone involved avoid actual
and/or perceived conflicts of interest.

5.2 A conflict of interest occurs when someone is in a position to make or influence a decision
about a grant that could benefit them, their family, their business, or an entity in which they serve
in a paid or voluntary leadership or advisory position.

5.3. All actual or perceived conflicts of interest need to be disclosed to the District Grant
Committee during the application process. If you’re not sure whether a situation presents a
conflict of interest, you should disclose it.
5.4 A. Please check the correct statement:
Clear selection
5.4 B. if you answered the above question "If there is a potential conflict, please describe the situation and how your Club has resolved this issue" please explain below
6. PUBLICITY *
How will the general public know this is a Rotary-sponsored project? Please provide details – for example: publicity in a newspaper or display of the Rotary Wheel (Rotary Signage can be a budget item, not to exceed $500).
7. REPORT *
The sponsoring club is required to complete and submit progress reports, final reports, and receipts/invoices to the district grants subcommittee. Please indicate below the individual who will take primary responsibility for submitting those reports.
Required
8a. SPONSORSHIP AND AUTHORIZATION
All Rotary clubs/districts involved in this project are responsible to the Foundation Grants subcommittee and ultimately to The Rotary Foundation for the conduct and reporting of the project. The affirmation  on this application confirm that the sponsors understand and accept the responsibility.
8b. SPONSORSHIP AND AUTHORIZATION *
By acknowledging below, you agree to the following: All information contained in this application is true and accurate, to the best of our knowledge.  This project will be carried out in accordance with Rotary Grants Terms and Conditions.  The club has agreed to undertake this project as an activity of the club.  We understand and will comply with the required Rotarian activities and reporting requirements as stated in the Criteria and Guidelines.  We agree that final reports will be submitted no later than two months after the completion of the project. Projects must be completed and final reports signed and submitted no later than June 24, 2024.  We agree to submit receipts for all eligible expenditures.We agree that club funds as listed in the submitted spreadsheet have been authorized.


The Rotary Club agrees to the above terms outlined in 8a and 8b:  Yes or No (If No, please
explain)
8c. If you answered the above question No please explain below
9. COMPLETION CHECKLIST
Before submitting your DG application, please take a minute to review this checklist and make sure that it is complete.
□ Does the project meet all DG criteria?
□ Has the sponsoring club appointed two contacts to oversee the project, and have they been correctly listed on the
application?
□ Is there funding aproval from the club president?
□ Is there a budget provided for the project?
□ Is there a cost estimate from the supplier for each item?
□ Has the section regarding project funding been completed? Does it equal the estimated budget?
□ Is a cooperating organization involved? If so, is a letter from that organization attached?
□ Have you outlined in detail how you plan to publicize the project?
□ Have you made copies of all documents for your records prior to sending them to the grants subcommittee?

Once you have submitted this application, email the Finance Template and voided Club check
and any other documentation to: skish33@gmail.com

                                                        District 6540 District Grants Chair:
                                                        Sharon Kish, District Grant Chair
                                                        skish33@gmail.com
                                                        219-508-1516
                               
A copy of your responses will be emailed to the address you provided.
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