District Grant (DG) Application 2022-23          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, 2022 APPLICATIONS ARE DUE NO LATER THAN MARCH 31, 2022
Preliminary Approval notifications expected APRIL 30, 2022. Final Approval expected MAY 30, 2022
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Email *
Your Name (first and last) *
Select Your Club Name *
Club Mailing Address
Your Phone Number *
 1a.Project Description *
Please describe the project, its location, its objectives, and how they will be attained. The project cannot be started until July 1 following the final approval of the District Grant Application by Rotary International Foundation.Summarize the proposed project. Provide a brief description and identify the primary beneficiary (the recipient of goods and/or services).
1b. What needs of the community will be served? *
How will the Rotary Club and all partners communicate and work together to implement this project? Please provide specific examples of activities and responsibilities
1c. Which of the Areas of Focus does this project serve?
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1d. ESTIMATED PROJECT START DATE:                  ESTIMATED PROJECT COMPLETION DATE: *
Projects must not be started prior to July 1, 2022. Projects must be completed and reported by June 30, 2023.
2. PARTICIPATING ORGANIZATIONS
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.
3. 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
3a. Name for second Contact *
3b. Email address for second Contact *
3c. Phone number for second Contact *
4. PROJECT BUDGET and 5. PROPOSED FINANCING
Complete template request for the project and indicate currency used (if other than $US). Email form to District Grant Char 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/
6. 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.
7. 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).
8. 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
9a. SPONSORSHP 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.
9b. SPONSORSHP 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 30, 2023.We agree to submit receipts for all eligible expenditures.We agree that club funds as listed in the submitted spreadsheet have been authorized.
10. 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 confirmation 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 form send the finance template and any other documentation to:

                                                        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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