CHARLES B. COZADD ROTARY FOUNDATION GRANT APPLICATION

GRANT PURPOSE

The Charles B. Cozadd Rotary Foundation's mission is to receive and administer funds for scientific, education, and charitable purposes that support the public good in Belleville, Sumpter and Van Buren Township as well as to support the efforts of the Rotary Club of Belleville.

The Foundation is primarily interested in projects that have a community-wide impact, and funding will not be provided to or for individuals. There must be accountability, follow-up and reporting for each application to be considered.

DEADLINE FOR SUBMISSION: Application deadlines are March 1st and September 1st of each year. Applications received after the deadline will be held for consideration at the next funding cycle.

Contact Information for Organization/Lead Individual

Organization Name *

First Name of Contact Person *

Last Name of Contact Person *

MI

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Tax ID # if requesting more than $5,000. (W9 form can be found at: https://www.irs.gov/pub/irs-pdf/fw9.pdf )

Project Description

Describe in detail the project/program for funds being requested. Be as specific as possible: *

Provide at least two bids for the purchase of any tangible property or provide invoices for other requests where bids do not apply:

In what time frame will this project/program be undertaken and completed? *

List sources and amounts of any fund available in addition to foundation funds, such as a joint grant. Is your organization amendable to structured payments or grant funds? (e.g. a percentage upon approval and the balance upon completion of your project). When will you need Foundation funds and in what amounts? *

By what methods and when will you measure the effectiveness of the project/program? What will you do with this information? *

What do you envision the short and long-term effects of this project to be? Be specific. *

Describe your organizational structure, goals and membership requirements. *

I agree that my organization will schedule an appearance before the Cozadd Rotary Foundation Board (or a regular Belleville Rotary Club meeting) explaining a final report of the completion, effectiveness and cost of the program. *

Yes

List anything else you want us to know about your program organization, etc., that will assist us to make the best decision on your request. *

Please feel free to submit any other supporting documents.

I certify that the above information is correct. (Please sign): *

clear