Online Grant Application (Read guidelines first) Please enable JavaScript in your browser to complete this form.LayoutName of Organization: *Parent Organization (if different): Organization Address: Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayoutName of Executive Director: *Executive Director Phone: *Previous Parole Rotary Foundation Grantee: *NoYesExecutive Director Email: *Total Organization annual revenue: *LayoutProgram Name: *Phone *Name of Program Director (primary contact): *Email *Brief descriptive title of your proposed program: (Less than 100 characters.) *Brief Program Summary: *Up to 400 character concise summary of proposed objective(s), target beneficiaries, and anticipated impact(s). LayoutTotal Program Budget: *Funds Requested from Parole Rotary Foundation: *Estimated number of AA county residents to be served by Parole Rotary Grant *LayoutPopulation served – check all that apply: *General population Low income/welfare HomelessStudent OtherIf Other, please specifyAges served – check all that apply: All<1213-19 20-34 35-65 >65LayoutProgram end date: *Date Program start date: *Primary category of request – check one category *EducationArts Health/Wellness Type of activity funds are requested *Service: work effort benefiting children, e.g. teaching, counseling, … Capacity Building: projects leading to lasting infrastructure that benefit children, e.g. sports equipment, trail building, bookshelves, ….Welfare: goods distributed to benefit children, e.g. food, clothes, scholarships, … File Upload - Attach Application Narrative * Click or drag a file to this area to upload. Upload Application Documents: Documents may be submitted in PDF and/or MS Word format. File Upload - Attached Budget Details * Click or drag a file to this area to upload. Upload Application Documents: Documents may be submitted in PDF and/or MS Word format. File Upload - Attach 501(c)(3) Certificate * Click or drag a file to this area to upload. Upload Application Documents: Documents may be submitted in PDF and/or MS Word format. File Upload - Attach most recent IRS Form 990 * Click or drag a file to this area to upload. Upload Application Documents: Documents may be submitted in PDF and/or MS Word format. By signing below, you affirm that your organization does not discriminate by race, creed, gender, sexual orientation, age, religion, disability, or national origin. SignatureClear SignatureUpon receipt of your application, the Program Director, (primary point of contact) will receive an email acknowledging your grant application was submitted.Apply