SHEBOYGAN ROTARY CLUB

2014REQUEST FOR FUNDING PROPOSAL

Applicants should e-mail copies of theapplication and any additional informationby December 1, 2014 to:

The Sheboygan Rotary Club’s main objective isSERVICE– in the community, in the workplace and throughout the world. Rotarians are dedicated to building goodwill and peace, providing humanitarian services and encouraging high ethical standards in all vocations. This year the focus of the Request for Funding Proposal (RFP)will be to be a local non-profit working on one of six needs supportedby Rotary International. They are as follows:

  • Peace and Conflict Prevention/Resolution
  • Disease Prevention and Treatment
  • Water and Sanitation
  • Maternal and Child Health
  • Basic Education and Literacy
  • Economic and Community Development

The organization chosen will receive a portion of the proceeds. A portion will also be allocated to Rotary International Projects (Polio, Water, Shelter Boxes) and a portion will be allocated to the Sheboygan Rotary Club Foundation to support on-going efforts.

Organization Name:

Organization’sDirector/Title:

Address:

City, ST, Zip: County:

Phone Number: Fax Number:

Website:

Email:

*FEIN#: *Applying organizations must have 501(c)(3)status.

Date of Incorporation: Organization Fiscal Year:

Nature of Request:

Capital Operating Endowment Program Project Other

Program/Project Name:

Amount Requested from the Rotary:

For any questions we may have pertaining to this funding application, please contact:

Application Contact/Title:

Application Contact Phone Number:

I. ORGANIZATION INFORMATION

  1. Please give us a brief summary of the organization’s mission and history, description of current programs and activities, number of persons served annually, and recent accomplishments.

IIa. OPERATING/CAPITAL/ENDOWMENT REQUEST: EXISTING NEW

  1. Statement of needs/problems,based on the six Rotary International focus areas, to be addressed and description of how Sheboygan County communities will benefit.
  1. Description of your organization’s vision and goals for the next 12 months.
  1. How many participants will be served through your organization? How many participants will beserved as a direct result of the Rotary funding?
  1. Please tell us about any other businesses or community volunteers and/or partner organizations who participate with your organization.

IIb. PROGRAM/PROJECT REQUEST: EXISTINGNEW

  1. Description of the program/project including statement of needs/problems to be addressed, based on the six Rotary International focus areas, and description of how Sheboygan County communities will benefit.
  1. Description of your organization’s vision and goals for the program/project in the next 12 months.
  1. How many participants will be served through your program/project? How many participants will be served as a direct result of the Rotary funding?
  1. Please tell us about any other businesses or community volunteers and/or partner organizations who participate in this program/project.

III. FINANCIAL INFORMATION

  1. Attach organization’s previous and current annual budget.
  1. Attach Program/Project Budget (if applicable).
  1. Statement regarding the organization’s audit procedures.
  1. Organization’s sources of revenue.
  1. List any other actual or potential sources of funding for the program/project.
  1. How will you sustain your program/projectfinancially in the future?

IV. EVALUATION

1. Plans for monitoring and evaluating success.

Please note a Year End Report is required of the Non-profit recipient specifying how funding monies were used.

V. ATTACHMENTS

The following attachments must be included in all Funding Applications:

  1. A copy of FEIN.
  1. A copy of the current IRS determination letter indicating 501(c)(3) status.
  1. Listing of Board of Directors

PARTNER AGREEMENT

The chosen partner will be expected to perform supporting duties to promote the Survey Says, being held March 21, 2015. The chosen partner will be viewed as an extension of the Sheboygan Rotary Club by actively engaging in the following:

  1. Actively promoting the Survey Says in the community, within the partner organization (board of director, mailing lists, previous benefactors, etc.).
  2. Securing the minimum of 2 teams.
  3. Provide a minimum of 40 volunteer hours during the day of the event.
  4. Sharing mailing lists of potential invitees.

By completing this application you agree to the above listed expectations.

Has the organization’s Director authorized this request? Yes No

The undersigned, an authorized officer of the organization, does hereby certify that the information set forth in this funding application is true and correct, that the federal tax exemption determination letter attached hereto has not been revoked and the present operation of the organization and its current sources of support are not inconsistent with the organization’s continuing tax exempt classification as set forth in such determination letter. I further agree to utilize any funding received specifically for the purpose as stated above.

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