CHECKLIST OF ITEMS TO PROVIDE TO THE ROTARY DISTRICT FHG COMMITTEE WITH YOUR

APPLICATION:

Required ItemIncluded?

1.Letter of participation from cooperating organization or memorandum of

understanding (page 3 of application); 

2.Detail budget narrative or spreadsheet (page 4); 

3.Project contacts and Club President signatures (page 5); 

4.All documents in electronic format 

Please note that if you do not submit any of the required components of your application, the application will be considered incomplete until such information is received; this will delay approval and distributions of grant funds.

Please read the Attachment and “Project Review & Evaluation Report” criteria before filling out this application. Please print or type all information and use additional sheets of paper if necessary. (Note District grant funds cannot be applied for to reimburse a club for projects completed or in progress):

1. ______

Sponsoring Rotary Club (Initiator of the grant request)Club mailing address

1a. Is your club a 501(c)(3)organization? Y/N? ______If Yes, what is your tax ID? ______

1b. Did your club receive funding last year? Y/N? ______

1c. If yes, is this a new project? Y/N? ______

If no, please describe in #4 below how you will you improve the project this year.

2. Please identify which of the 7 project focus areas these funds will be spent on:

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Homelessness prevention efforts 

Coordinated access to support services

Rapid re-housing 

Tailored support services & programs 

Economic opportunity

Creating reliable data 

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Advocacy 

______

Estimated Start Date Estimated start dateEstimated Completion Date
must be completed by 6/30/13

3. Describe the project, its location, and its objective(s). Project objectives must use SMART criteria: Specific, Measurable, Attainable, Relevant, and Time-bound.

4. Describe how project is specifically targeted towards the focus area(s) serving homeless families; families at imminent risk of homelessness; and/or improve the condition for homeless families in your community. If your club received funding last year, please describe how you will improve the project this year.

5. Describe non-financial participation by Rotarians in the project. (i.e., participation in hands-on Rotarian activities, physical labor, in-kind contributions).

6. Project Contacts – Two Rotarians must be listed who will provide oversight and management of the project funds.

a. ____________

Primary ContactRotary Position or titleMailing address

E-mail address ______Telephone No. ______

b. ____________

Secondary ContactRotary Position or titleMailing address

E-mail address ______Telephone No. ______

7. Cooperating Organizations – Your Club must partner with organizations or agencies serving homeless families in the community that are 501(c)(3) public charities. Please provide the name of the primary partner organization. Attach a letter of participation from that organization or a Memorandum of Understanding between Rotary and the other organization that specifically states its responsibilities and how Rotarians will interact with the organization in the project. By signing this application, the Rotarian sponsor endorses the organization as a reputable 501(3)(3) charitable organization; and that it is registered with the state.

______

Name of Cooperating Organization Cooperating Organization contact person & phone no.

7a. Provide the Partnering Organization tax ID #: ______

8. How will the project create public awareness about family homelessness and/or that it is a Gates Foundation/Rotary-funded project? Provide details of planned publicity and display of Rotary emblem if appropriate.

9. Each club is required to have an annual presentation on homelessness at one of your regular club meetings. If you have an ongoing project, you should be receiving regular progress reports. What type of educational program or progress report on homelessness has your club received in the last 12 months?

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10.

DATE: / FAMILY HOMELESS GRANT BUDGET
PROJECT SOURCES OF INCOME: / INCOME
a. Sponsoring Rotary Club’s Commitment / $0.00
Grant is $ for $ match of Club’s seed $; minimum $2500 up to maximum $10,000
B. Requested FHG funds / $0.00
Note: Please identify in-kind contributions and dollar value of volunteer time in detailed budget attachment. Independent Sector estimates value of volunteer time in Washington @$21.01/hour). List funds contributed below. Use detailed budget attachment for more.
SOURCES OF FUNDS
1) / $0.00
2) / $0.00
3) / $0.00
C. Total funds from other source(s) / $0.00
Total Project Income for this project: / $0.00
INTENDED USES OF PROJECT FUNDS:
a. Material to be purchased: / $0.00
Attach a list of expected purchases and invoices for all individual items
b. Advertising and copies costs: / $0.00
Attach invoices.
c. Shipping and transportation costs: / $0.00
Attach invoices or documentation of mileage (e.g., Google Maps)
d. Specialized labor costs: / $0.00
Provide quote e.g. licensed electrician
e. Other labor costs: / $0.00
Attach invoices.
Total project dollars to be spent for this project: / $0.00

11. Authorization – The sponsoring Rotary Club is responsible to the District for the conduct of the project and accountability of all District grant funds. The signatures on the application confirm that the sponsors understand and accept the responsibility for the stewardship of FHG funds and affirm that all information in this application is true and accurate to the best of their knowledge. The president’s signature affirms that this project has been approved by the Club’s Board of Directors as a club activity but will not be started until receipt of approval of the FHG Committee.

Electronic copies of this grant application will be as equally binding as originals and faxed or scanned and emailed counterpart signatures will be sufficient to evidence your responsibility, though the FHG Committee may require you to deliver original signed documents.

______

Primary Contact SignatureSecondary Contact Signature

______

Club President’s name (printed)Club President’s Signature DateEmail address

12. Approval – This grant request is: approved / disapproved / returned for additional input:

______

District FHG Committee ChairpersonDate

13. Funds delivery: – Upon approval of the District FHG Committee Chairperson the project may begin and the sponsoring Rotary Club may commit grant funds up to the amount authorized. The District will forward the actual funds to the organization specified below in the amount of the grant, upon approval of the grant.

______

Organization name that will go on the checkAddress where check will be sent

If a project is longer than six months, an interim report is due at six months. Final reports are due to the district within one month of completion of the project and in all cases no later than 6/30/2013.

The Rotary-Gates FHG Committee requires you to send your application electronically. Sign and date your application, scan it, and e-mail it to: .

Please keep a copy of your original on file.

Attachment only – not part of Grant Application

Criteria for using District Family Homelessness Grant Funds:

Rotary District 5020 partnership with the Bill & Melinda Gates Foundation is perfectly aligned with the Foundation’s strategy to address family homelessness. Rotary Club projects provide the opportunity for the Foundation to engage local leaders in tackling the problem of family homelessness in a way that is consistent with Rotary’s focus on improving the lives of people in their communities. While Rotary does not engage in direct lobbying efforts, projects provide Rotary members opportunities to learn more about the nature and causes of family homelessness. In addition, Rotarians provide innovative approaches and business expertise in their communities to address the issue. Despite ongoing work by the Foundation and other organizations, existing community and statewide responses to combat family homelessness focus more on crisis intervention or short-term help rather than long-term solutions to permanently end family homelessness. As more Rotary clubs take on projects that serve homeless families, Rotary raises the profile of the issue among business and civic leaders and increases the community’s commitment to end family homelessness..

The individual projects undertaken by local Rotary clubs to address homelessness in their communities will be consistent with the Foundation’s system change agenda for family homelessness. The principles that guide the Foundation’s investments also provide the framework for the kinds of projects that a Rotary club may select for the matching fund projects.

Matching funds provided by the Foundation to Rotary District 5020 are meant to support local club projects that are specifically targeted towards serving homeless families and families at imminent risk of homelessness. Matching funds will be used to support projects that focus on the following areas:

  1. Prevention efforts: Services such as eviction prevention, landlord mediation, financial help for families to pay overdue rent or utilities or other efforts to divert families with housing alternatives away from shelter.
  1. Coordinated access to support services: A common point or process of entry and/or intake into the support services system. Using a universal assessment protocol to identify a family’s needs and individual housing barriers so they can get the right help at the right time.
  1. Rapid re-housing: Effective efforts to reduce a family’s stay in emergency shelter by quickly placing families into permanent housing, some with short-term rental subsidies and others with transitional or permanent supportive housing.
  1. Tailored services and programs: Flexible, coordinated, and tailored support services so that families get the help that matches their unique needs to maintain stability and increase economic security.
  1. Economic opportunities: Ultimately, families need to increase their economic security in order to prevent them from coming back into the homeless system. We need to build a strong bridge for families recovering from homelessness to connect with education, training, and workforce development opportunities.
  1. Data: We need accurate data on the number of homeless families; what they need, what services are being provided and by whom, and whether or not families come back into the homeless system. Reliable data will provide progress tracking and the opportunity to make course corrections.
  1. Advocacy: Rotary can help foster a public commitment to realign existing funds and provide new dollars to support our promising and innovative practices. Ending homelessness depends on continued and increased public support for an adequate supply of safe, decent, and affordable housing.

Additional reminders that Rotary projects should:

  1. Be publicly identified as a Rotary Project.
  2. Be of a short-term nature with the expectation that they will be completed no later than one year following dispersal of grant funds.
  3. Sponsors must provide a final report within one month of a project's completion and in no event later than one year after dispersal of grant funds. If a project is longer than six months, an interim report is required at six months.
  4. Have two contacts in the club who are responsible to oversee and complete the project and final report.

Project sponsors must agree to work within the Rotary Foundation Trustee established Stewardship Guidelines and utilize the Financial Guidelines and Regulations for Humanitarian Grant Projects. Good stewardship is mandatory. Accountability (i.e. receipts, documentation of expenditures) of Rotary funds/District funds is required. Clubs are required to use generally accepted accounting standards. Two signatures are required on all checks written for approved grant project expenditures. Any deviations from the approved grant must be obtained from the FHG Committee. Funds not expended in accordance with the approved grant or approved changes will be promptly returned to the FHG Committee Treasurer. Failure to promptly return funds, or submit required reports, will result in the Club being suspended from any future consideration for any type of grant, Gates Grant or Rotary Foundation Grant, for up to five years.

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