AUBURN ROTARY CLUB - COMMUNITY NEEDS GRANT REQUEST
This form is used to request the allocation of Community Needs funds in accordance with the PROCEDURES section. Please provide as much information as you believe appropriate to support your request. Completion of all items is not mandatory. This information will be used by the Community Needs Committee for preparing a priority listing for recommending the award of funds. Final grants will be decided by the Club Board.
(Use reverse side of page for any additional information)
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Agency/Program ________________________________________________________________
Principal Agency/Program Contact :
Name___________________________________________________
Title_____________________________________________________
_________________________________________________________________________________________________
B. Are you a not-for-profit organization that has been declared tax exempt by the IRS, or have 501(C)3 tax deductible purposes? Yes_____ No____
C. Does your organization look to a Board or governing body for guidance? Yes____ No_____
D. Do you charge fees for services or membership? Yes ____ No_____.
If yes, please give examples. ______________________________________________________________________________________________________________
E. What other local area agencies provide the same or similar service? ___________________________________________________________________
_____________________________________________________________________________________
F. Please check the areas served.
Auburn only _____, Lee county _____, Outside Lee County _____
G. Numbers of Clients Served
Ages Daily (#) Weekly(#) Annually(#)
<6 _____ _______ _______
6-18 _____ _______ _______
19-60 ______ _______ _______
>60 ______ _______ _______
H. Staffing.
Number of employees:
Full time _____, Part -time______ , Unpaid volunteers _______, Contract personnel _______
I. Budget/Expenditures (annual): $
Staff salaries/benefits. _____________
Indirect/admin costs. _____________
Fund raising _____________
Direct support to clients _____________
Other _____________
Total _____________
J. Sources of funds % of total
Local contributions _____________
Fees and sales _____________
City and County funding _____________
State funding _____________
Federal funding _____________
Earnings from reserves/endowments _____________
K. Funds in reserve as a percent of annual budget ____________%
L .Amount requested $________________________
M. Please describe how these funds will be used to serve to the needs of this community.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
N. Summary justification for request.
Since annual requests exceed funds available it is necessary to allocate the available funds on a priority basis. Factors considered for ordering priorities include:
(1) Direct support to the needy. Highest priority goes to those providing direct support for the welfare, security, and education of the most needy children, families and elderly; compared to those providing only limited support to these groups .
(2) Impact on the community. Highest priority goes to those having a major impact on the community-at-large; compared to those having limited visible impact.
(3) Funding sources. Highest priority goes to those with only limited and local sources for funds; compared to those wide a wide range of sources and reserves/endowments.
(4) Overhead/indirect costs. Highest priority goes to those with comparatively low overhead and indirect costs to client benefit ratios;; compared to those with high overhead/indirect costs-to-benefits ratios.
(5) Dependence upon traditional Rotary Club support. Consideration is given to those programs and projects which have depended upon Rotary in the past for continued successful operations.
Please give information about your program/project that will help the Committee to assign a relative priority to your request.
(1) Direct support to the needy. _________________________________________________ __________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________.
(2) Impact on the community-at-large. ____________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________________________________________
(3) Funding sources. ____________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
(4) Overhead/indirect costs. ___________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
____________________________________________________________________________________
___________________________________________________________________________________.
(5) Dependence upon traditional and continued support from Rotary..
___________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________.
Requesting agency/program representative:
Name and signature.___________________________________________________________
Contact telephone no. _________________________________________________________
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To assure all requests receive equal consideration , please submit your written request not later than January 10, 2010. Please send your request in care of:
Dan Nichols
101 Prathers Lake Dr
Auburn Al 36830