Grant Application Form

Type of Request

General Donation (One-time gift)

Emergency Need (Up to $500, unless otherwise approved by the Board of Directors)

Date of Request

Amount Requested

Organization

Organization Website

Organization Address

City

State

Zip

Person Requesting Donation

Phone

Email

Position with Organization

Are you authorized to request funds on behalf of the Organization?

Yes

N

Tax Status

501(c)3

501(c)4

Other

Tax ID

Description of Project/Need (If this is an emergency request, please explain circumstances)

Briefly describe the Organization's primary purpose/mission.

Please name any Tulare Rotary Club members affiliated with this Organization (if any)

Has the Tulare Rotary Club given to your organization in the past 12 months?

Yes

No

What other local funding sources are available to support your project/need?

By checking this box, I (We) affirm that the information being provided is true and correct to the best of my (our) knowledge. I (We) also consent, should a donation be awarded, to the use of the Organization’s name and other information, logo, photos of the Organization and its agents, etc. in any promotional material generated by The Tulare Rotary Club for their use. I (We) also consent to creating a Public Service Announcement (PSA) about the donation for local news outlets if so requested by the Club. If a donation is awarded, I (We) also agree to have a representative from the Organization attend a Tulare Rotary Club meeting to formally receive the donation, if schedules permit. I (We) also agree to provide a Tax Acknowledgement Letter for any donation given and provide evidence of our 501(c)3 status, if so requested by the Club. I (We) agree that this form and any additional information provided to The Tulare Rotary Club about the Organization will be kept and not returned regardless of whether or not the request for donation is approved or declined.

I agree

Name of Requestor

Title of Requestor

COMMUNITY GRANT APPLICATION

Tulare Rotary Club 2024 Grant Application

CLUB INFO

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