Donation Request Application

The Rotary Club of Qualicum Beach is pleased to consider your application for financial support when it can. The Club tends to prioritize small, local organizations which are trying to help youth or seniors. It is particularly interested in supporting programs where the relatively modest financial assistance can make a real difference. The Club is most interested in helping people, and investing in physical facilities is typically a lower priority. Requests will be considered on a quarterly basis, with submission deadlines as follows: July 15th, October 15th, January 15th, and April 15th.

Our Vision statement is: “To make a positive difference to youth and families in local and global communities by working together and fostering fellowship among all members.”

As “People of Action”, Rotarians have identified the following 8 areas of focus:

Basic education and literacy
Economic and community development
Maternal and child health
Supporting the environment
Clean water and sanitation
Peace and conflict resolution
Disease prevention and treatment
Mental health

Please elaborate on your funding request through the following questions on the following pages keeping in mind whether your request falls within Rotary’s 8 areas of focus.

PLEASE NOTE: THE ROTARY CLUB OF QUALICUM BEACH DOES NOT PROVIDE FUNDING FOR “OPERATING COSTS”

Once you’ve completed the following information, please submit your request within one of the submission dates listed above by email to: rotaryclubofqualicumbeach@gmail.com. We will try to answer your request within a timely manner but it could take at least another month from the submission date as our funding allocation committee will review the request first and then their suggestions will need approval at the following board meeting.

Sincerely,
Rotary Club of Qualicum Beach

Please complete one application for each project for which you are requesting funding. Any additional supporting documentation or information may be included as attachments.

Donation Request Application

Official Name of Organization (or full name if an individual)

Mailing Address

Telephone

(Optional tel.)

E-mail

Contact Person

Position

Briefly outline your organization, noting some of its history, members involved, and other projects previously completed or currently underway

Number of staff

Paid

Full-time

Part-time

Volunteer

Describe the project, its location and its objectives

Briefly describe the short and long-term objectives of the project

Clearly list the items requested, or the items funding is requested for and their value

Describe how the project will benefit the community and/or improve the lives of the intended recipients

List other sources of revenue, including amounts that have been applied for or obtained

Does your organization have Canada Revenue Agency “Charitable Organization” Status?

Yes

Do you or your organization receive funds from the BC Gaming?

Yes

BC Gaming Amount

Do you charge for any of the services you provide?

Yes

How much is charged and how is the amount determined?

Please provide the most recent financial statements

Maximum file size: 67.11MB

Copy attached for the year of

Please provide a budget for the current year

Maximum file size: 67.11MB

Copy attached for the year of:

How will the general public know this is a Rotary-sponsored project? Provide details of planned publicity and display of Rotary emblem if appropriate. Donor recognition is appreciated but not essential to a grant being made.

Signature

Clear

Print Name

Position

Date

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