District Simplified Grant #

/ /

Individual Project Report #

/

To be completed by each Club that received a grant. Return this form along with any photos you have by January 15th 2010 to: DSG Coordinator Dr. Steve Miller, 4303 – E Avenue, Anacortes, WA 98221USA 360-293-8683 FAX 360-293-7533. Final report due by March 15, 2010.

Rotary Club:
Project Title:
Progress Report / Final Report
Project Description

1. Briefly describe the project. What was done, when and where did project activities take place, and who were the beneficiaries?

2. How many Rotarians participated in the project?

3. What did they do? Please give at least two examples.

4. How many non-Rotarians benefited from this project?

5. What are the expected long-term community impacts of the project?

6. If a cooperating organization was involved, what was its role?

Financial Report (District must retain receipts of all expenditures)

7. Income Amount

1. District Simplified Grant funds received from the District
2. Other funding (specify)
3.
Total Project Income

8. Expenditures (please be specific and add lines as needed)

1.
2.
3.
4.
5.
6.
7.
Total Project Expenditures

9. By signing this report, I confirm that to the best of my knowledge these District Simplified 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. Receipts for all grant-funded expenditures have been provided to the district.

Certifying Signature / Date:
Print name, Rotary title, and club

District Simplified Grant Project Report Instructions:

DSG’s differ from Matching Grants in that the DISTRICT gets the funds in a block from the Rotary Foundation, and uses them for several individual grant projects in accordance with the terms and conditions established by the Foundation Trustees. With a Matching Grant a ROTARY CLUB applies and receives the funds directly from the Rotary Foundation for their project. With a District Simplified Grant reporting is done through the District, not directly to the Foundation. The attached form should be used to complete the report, and then it should be mailed as directed above.

Important Due Dates: If your project is completed now, please send the report in now. If you will complete it by the deadline of March 15 2010, we ask that you submit a progress report by January 15th with as much information as you have on the project. It will be sent to the Rotary Foundation with the other reports on this project.

In order to qualify for a 2010-11 District Simplified Grant, District 5050 must have all final reports from Clubs in by March 15, 2010 for all the 2009-10 grants. It is expected that all project related activities will be completed by then on grants issued to Clubs by that time. Use this form for either report.

Complete the report according to the information in each section.

Under financial reporting, list the amount of your grant on the top line and any funds that your Rotary Club, or another organization provided. Make sure that Income and Expenditures balance.

Be sure to save receipts for three years, should this grant ever get audited by the Foundation. Send copies of your receipts with your report.

Sign and date the report and send it in!

Please……don’t forget to send some project pictures (preferably digital)!