Grant Application

Please complete this application in full, attaching appropriate documents as necessary. Applications not meeting funding guidelines, or not filled out completely, may be returned or rejected.

* Indicates required field

Organization Name *

Contact Person Name *

First

Last

Contact Person Title *

Email *

Phone Number *

Fax Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Total Funds Requested *

Purpose of Request
Briefly describe the reason for your request. Please be as specific as possible. Attach a separate sheet if necessary.

Purpose *

Mission Statement
Please provide your organization's mission statement.

Mission Statement *

Expected Outcomes
What do you plan to accomplish with these funds? Please describe the measurable outcomes.

Expected Outcomes *

Benefit
Give a brief description of how these funds will benefit or improve the health, education and general welfare of the residents of Vancouver and/or Clark County, Washington, and well-being of our community. How many people and what segment of the community will benefit?

Benefit *

Funding

Attach a budget for your project. Please provide a detailed breakdown, including equipment, supplies, salaries, etc. (NOTE: We do not normally fund salaries).

Upload File *

Max file size: 20MB

Please provide details as to the basis for your price estimate (i.e. bids, price quote, estimate).

Upload File *

Max file size: 20MB

Did you request a nonprofit/charity discount, and will one be given? *

What type of discount? *

Are there other funds currently available for this project *

If so, please indicate the source and explain. *

Have you considered a matching contribution? *

If not, is that an option for funding this project? *

Have you submitted requests to other organizations? *

If yes, please list the top five and the status of those requests *

Have you received funding from the Rotary Club of Three Creeks Foundation before? *

Yes No

How much? *

When *

Project Plans: What is the timeline for your project and who is responsible for the outcome? *

Charitable Status: Is your organization a public charity (i.e. 501(c)3) *

Yes No

Attach a copy of your IRS 501(c)3 determination letter. Note that the Rotary Club of Three Creeks Foundation will consider grants only to nonprofit charities which are 501(c)3 organizations and does not give funds to organizations that are classified as 509(a)3 supporting organizations.

Upload File *

Max file size: 20MB

Financial Information: Please provide your organization's last three years income statements and balance sheet statements. If three years of financial records are not available, please explain why. Please also provide a copy of your latest IRS Form 990 tax return that was filed with the IRS.

Upload File *

Max file size: 20MB

Comment *

If you receive the requested grant, what are your plans to recognize the Rotary Club of Three Creeks Foundation for its contribution? *

Signature *

Date *

Title *

The Rotary Club of Three Creeks Foundation reserves the right to accept, reject or limit grants in any way it deems necessary. You will be notified of the Foundation's decision on your grant application by letter.

Submission Deadlines
The Foundation's board of directors will review grant requests once each year in September-November. Our fiscal year is July 1-June 30, and completed grant requests - including all required attachments - must be submitted to the Foundation by July 1 to be considered for our September-November review. We will consider all completed community grant applications. Our intent is to announce grant winners during December of each year.

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Grant Application

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