Special Request Form

 

 

ORGANIZATION:  [Full Legal Name]   
 
 
 
 
NAME OF CONTACT PERSON, MAILING ADDRESS, PHONE NUMBER, AND EMAIL:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TAX STATUS: [State whether a 501(c)(3), and include ID number]
 
 
HISTORY:       [Briefly recite history of the organization and prior grants from Moorestown Rotary Clubs]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PROJECT:[Explain the project and show what the funds will be used for.  Include a detailed budget.]    
 
 
 
 
 
 
 
 
 
 
 
COMMUNITY BENEFIT:  [Explain what the Moorestown (or other) community can expect to get as a result of this particular project.]
 
 
 
 
 
 
 
 
REQUESTED GRANT:  [Specify dollar amount.]
 
 
 
 
 
EFFORTS TO SELF-FUND:  [List other sources from which you have attempted to raise funds;  tell us what fundraising events you have held or plan to hold for this project and how much you have raised from these efforts.]
 
 
 
 
 
SPONSORING ROTARIAN:  [Name of Moorestown Rotary Lunch Club Rotarian]
 
 
 
 
CLUB CREDIT/BENEFIT:  [Specify how the Club’s grant will be publicly recognized.]
 
 
 
 
 
 
DATE OF REQUEST:  [Date emailed or delivered to our Club.]
 

 
Please email requested information to: wendy@wendyholdenasid.com