Glens Falls Rotary - Box 4702, Queensbury, NY 12804

Application For Funding

Rotary Club of Glens Falls, New York

Application for Funding ($500 or more)

1. Date __________________

2. Requesting Organization: ___________________________

3. Address: _________________________________________

(Please provide the complete name and mailing address of your organization. If funding is approved, this is where the check will be mailed.)

4. Person Making Request: __________________________
Phone #: ________________________

5. Name of Project: ___________________________________________

6. Has this project been funded before by Glens Falls Rotary? YES NO (circle one)

7. Please briefly describe the project, how Rotary funds would be used,
and other sources of funding:

____________________________________________________________________________________________

8. Please describe how the project fits into one of the Avenues of Rotary
Service (Club service (strengthening fellowship and functioning of the
Club), Vocational service (serving others through our vocations while
practicing high ethics), Community service (projects and activities to
improve life in the community), and International service (to expand
Rotary’s humanitarian reach to promote world understanding and
peace):

____________________________________________________________________________________________

9. How could Glens Falls Rotarians personally assist in the implementation of the project? ____________________________________________________________________________________________

____________________________________________________________________________________________

10. If funding is provided by Glens Falls Rotary, how will the Club and Rotary be acknowledged publicly for their contribution (signage, etc.)? ____________________________________________________________________________________________

____________________________________________________________________________________________

Amount Requested: __________________

Date Required: _____________________

Please mail this application to:

Rotary Club of Glens Falls

PO Box 4702

Queensbury, NY 12804