Online Grant Application

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Name of Organization: *

Parent Organization (if different):

Organization Address:

Address Line 1

Address Line 2

City

State

Zip Code

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Name of Executive Director: *

Executive Director Phone: *

Previous Parole Rotary Foundation Grantee: *

No
Yes

Executive Director Email: *

Total Organization annual revenue: *

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Program 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).

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Total Program Budget: *

Funds Requested from Parole Rotary Foundation: *

Estimated number of AA county residents to be served by Parole Rotary Grant *

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Program end date: *

Date Program start date: *

Primary category of request – check one category *

Education
Arts
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.

Signature

Upon receipt of your application, the Program Director, (primary point of contact) will receive an email acknowledging your grant application was submitted.

(Read guidelines first)

By signing below, you affirm that your organization does not discriminate by race, creed, gender, sexual orientation, age, religion, disability, or national origin.

Upon receipt of your application, the Program Director, (primary point of contact) will receive an email acknowledging your grant application was submitted.