Special Request Form

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MOORESTOWN ROTARY 2009-2010 SPECIAL REQUEST

ORGANIZATION:  [FULL LEGAL NAME]   

NAME OF CONTACT PERSON, MAILING ADDRESS, PHONE NUMBER, AND EMAIL:

TAX STATUS:   [State whether a 501(c)(3), and include ID number]

HISTORY:             [Briefly recite history of the organization and prior grants from Moorestown Rotary Clubs]

PROJECT:  [Explain the project and show exactly what the requested funds will be used for.  Include a detailed budget.]

COMMUNITY BENEFIT:  [Explain what the Moorestown (or other) community can expect to get as a result of this particular project.

REQUESTED GRANT:  [Specify dollar amount.]

EFFORTS TO SELF-FUND:  [List other sources from which you have attempted to raise funds;  tell us what fundraising events you have held or plan to hold for this project and how much you have raised from these efforts.]

SPONSORING ROTARIAN:  [Name of Moorestown Rotary Lunch Club Rotarian]

CLUB CREDIT/BENEFIT:  [Specify how the Club’s grant will be publicly recognized.]

DATE OF REQUEST:  [Date emailed or delivered to our Club.]

Please email completed application to John Coleman, colemanjm@comcast.net