The Rotary Club of Sarnia
P.O. Box 22014, Twin Lakes Postal Outlet
1210 Michigan Avenue
Sarnia, Ontario, N7S 6J4
 
Application for Financial Support
 
When submitting requests for financial support and/or funding from the Rotary Club of Sarnia, we ask that you consider the following guidelines in order to be considered for assistance.
 
We do recognize there will be exceptional circumstances when requests must be submitted with short notice – all other requests should be submitted in a timely manner so the Rotary Club can budget for all outgoing funds.
 
Our general guidelines are as follows:
 
1.         Contact person, telephone number, email address
 
2.         Full description of request including goals, who will benefit and how.
 
3.         Estimated total cost or annual budget or business plan and timeframe of the  initiative.
 
4.         Specific amount of the financial request from the Rotary Club of Sarnia
            and date required.
 
5.         Names of other sources (with amounts) contacted for funding and
            confirmed funding you have received or anticipate receiving for this project.
 
6.         Notes on Government funding available and whether application has been made            
             - Municipal, County, Provincial, Federal.
 
7.         Are you a registered charitable organization – and do you issue tax receipts?
 
8.         Donor recognition – how will donors contribution be acknowledged?
 
Please note: If funds are received from The Rotary Club of Sarnia, a summary report is required confirming project completion, describing the project and goal achieved, and accompanied by photographs.
A member of The Rotary Club of Sarnia will follow up your application with additional questions if needed.
 
 
Name of applicant:___________________________________                                                                                                               
Address:                  
                                                                                                        
                                                                                                                                               
Telephone number:                                                                                                             
Email address        :                                                                                                                     
Contact person      :       
                                                                                                             
1.         Reasons for your request for financial support:
(a)        Name of the project:                                                                                             
(b)       Brief Description of the Project:                                                                                        
 
 
                       
                                                                                                                      
(c)        Goals of the project:                                                                                                                                       
                                                                                                                                                
 
 
                                                                                                          
(d)       Who would benefit and how:                                                                                                                                                
 
 
 
                                                                                                                                                                                                                                 
2.         Estimated total cost or annual budget or business plan and
             timeframe of the  initiative:
               
 
                                                                                                                                                                                                                                                                                
3.         Amount:                                             Date required:                                  
 
 
 
4.         Names of others sources (with amounts) you have asked for funding:
                                                                                                                                                                                                                                                                                                                                                                                                                                               
5.         Government funds available for project:                Yes                No      
            Has application been made for funding from?
            Municipality:                                                               Yes                No      
            County:                                                                        Yes                No      
            Province:                                                                     Yes                No      
            Federal Government:                                                 Yes                No      
6.         Are you a registered charitable organization:         Yes                No      
            Do you issue tax receipts:                                         Yes                No      
6.         Donor recognition:
            How will Rotary contribution be acknowledged?
                                                                                                                                               
                                                                                                                                               
Please note: If funds are received from The Rotary Club of Sarnia, a summary report is required confirming project completion, describing the project and goal achieved, and accompanied by photographs.
 
Submit your request by mail to:       The Rotary Club of Sarnia
                                                            P.O. Box 22014, Twin Lakes Postal Outlet
                                                            1210 Michigan Avenue
                                                            Sarnia, Ontario, N7S 6J4
Or by email to:                                   info@rotarysarnia.org
 
Disposition of request:
Date:
 
Granted         
 
Deferred        
 
Declined        
 
Comments: