Rotary Foundation of Sammamish

Community Service Project Application Form

Requesting Organization Information

Organization Name / Today’s Date
Organization Website / 501 (c) 3 / Yes No
Address:
Street Address / Apartment/Unit #
City / State / ZIP Code
Executive Director Name / CEO Name
Project Contact Person / Title
Project Contact Email / Contact Phone

Project Details

Title of Project
Proposed start date / Proposed end date / Is Project ongoing? / Yes No
Project description
Project objective and goals
How is this Project sustainable?
Amount requested / $
Which Area Of Focus does this Project address?
Children Seniors Families Homelessness Disabilities
Explain:
Who are the Project beneficiaries?
In what ways will your target demographic benefit?
How many people will benefit from this Project? / What are their ages?
How will you measure the success and effectiveness of this Project?
Do you have additional donors? / Yes No / If yes, list additional donors
In what non-financial ways can the Rotary Club of Sammamish participate in this Project?
Describe how you will notify your membership and the general public of Rotary’s involvement in the Project?
Does your organization agree to submit a final report providing a results oriented summary of the Project and verification that the funding was used for the approved purpose including all receipts and a final budget? / Yes No

Likeminded individuals are always welcome to join us in our many projects as a volunteer, friend, or prospective Rotary Club of Sammamish member. We invite you to learn more about our club online at www.SammamishRotary.org or visit our Facebook page https://www.facebook.com/SammamishRotary.

Application Checklist

Application
Itemized budget for Project
2 price quotes for items or services above $100
Form 990 if applicable
Additional supporting documentation (Optional)

Thank you for submitting this project idea to the Rotary Club of Sammamish. We look forward to learning more about the many ways you serve our communities.

Rotary Club of Sammamish Community Service Committee

Rev.6/15/2017

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