District Grant Income and Expense Report

FILL OUT THIS FORM AND SCAN IT ALONG WITH YOUR RECEIPTS INTO A SINGLE DOCUMENT AND UPLOAD IT INTO THE DOCUMENTS SECTION OF YOUR DISTRICT GRANT

1. File your District Grant’s Final Report in DACdb:

When you fill out and save the Final Report, it will be filed as a .pdf file in the Document Section of your grant application.

2. List ALL the Final Income and Final Expenses below.

Income & Expenses must equal each other:

Income

Sources of Income / Amount
1. District Grant funds received from the District
2. Cash from our Rotary Club
3. Cash from the Rotary Club of______
4. Cash from the Rotary Club of______
5. Other Funding (specify)
6. Other Funding (specify)
Total Project Income

Expenses (please be specific and add lines as needed)

Budget Items (receipts required) / Name of Supplier / Amount
1.
2.
3.
4.
5.
6.
7.
8.
Unspent Income (if any)
Total Project Expenses(must equal income)

3.Scan All Receipts and Number them from the Expense List above. Upload them into the Document section of your grant application and label the file “Expenses”. If your list of expenses exceeds the number of lines above, please include a spreadsheet that correlates to each of your receipts with a total that matches Total Project Income.

4.Certifying Signature

By signing this report, I confirm that to the best of my knowledge these District Grant funds were spent only for eligible items in accordance with Trustee-approved guidelines, and that all of the information contained herein is true and accurate. I also understand that all photographs submitted in connection with this report will become the property of District 5100 and will not be returned

Date: ______

Certifying Signature: ______

Print name and Rotary Title: ______