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Grant Application Form
Please complete this form for any request of funds from our Kirksville Rotary Club. Please note, our board meetings are the third Thursday of every month where we vote on any requests. Thank you.
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Email
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Record my email address with my response
Group/Organization Applying:
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Website:
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Address:
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Contact Person (Title, phone number, email,)
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Your answer
Club Sponsor
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Project Title:
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Projected Start Date
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DD
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YYYY
Projected End Date
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MM
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DD
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YYYY
Geographic Area Served by Project:
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Your answer
Number of People Served by Project:
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Donation Request Amount:
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Total Projected Cost:
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Project Summary Description (email flyer or other information if necessary to mstuart@atsu.edu )
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Your answer
By submitting this form - I acknowledge that all the information above is truthful and accurate to the best of my knowledge.
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Yes - all information to my knowledge is truthful and accurate. I understand that selecting this option represents my signature.
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