Youth & Senior Services Funds Request

Youth & Senior Services Funds Request Form

Use this form to request funds from the Cadiz Rotary Club for your organization or group. Please fill in all fields, and if a field does not apply to you, place “N/A” as ALL the fields on this form are required to request funds from the local Rotary Club. The Rotary Club needs all the information that you can provide so your request will be given full consideration. Forms will be reviewed every 2nd and 4th Tuesday of each month. Submissions are due at least one week prior to these review dates.

Organization*
What's the name of your organization wishing to request funds?
Contact Person*
FirstLast
Phone*
Email*
Mailing Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Request Description*
Give us an idea of what project or event you have in mind for requesting funds from the Rotary Club.
Total Amount Required to Fund This Entire Request*
$
How much does your Group plan to raise on your own?*
$
Total Amount Needed by Applicant(s)*
$
Number of Students/Senior Citizens Involved*
Date These Monies Needed by*
Project Description
Describe your Project, if there is NO Direct Involvement of Trigg County Students/Senior Citizens
Describe How and When Funds will be used.*
*If less than the total amount awarded will be used, the remainder will be returned to the Rotary for further distribution.
Applicant(s) receiving $1000 or more will be required to provide the Rotary Club of Cadiz with an itemized statement of how these funds were used.
Would your group be willing to present to the Rotary about the outcome of your event?*
- Yes
- No
Please list other funding sources for your project/event and the amounts contributed/expected.*
For tax purposes, please list whether or not your organization is associated with the following*
- Trigg County School District
- Trigg County Government/City of Cadiz/State of KY
- Church Group/ (Please identify the Church)
- Senior Citizen / Nursing Home / Health Care Facility
- Other
Please Identify the Church
Are you tax exempt under 501(c) under the Internal Revenue Code?
- Yes
- No
If tax exempt, which sub-section?
If you answer “Other” please provide the following information in this same box.
1) Name of your Board and Elected Officers
2) Are you chartered as a Not for Profit Organization?
3) If no Board of Directors, does your organization have a President, Secretary or Treasurer?
Every application submitted to the Youth and Senior Services Committee must comply with all funding requirements of both the Rotary Club of Cadiz and Rotary International
By Signing/Typing my name below, this Constitutes my Electronic Signature which is REQUIRED to Submit this Request for Funds to the Cadiz Rotary Club. I have read the Guidelines as set out by the Cadiz Rotary Club and this signature verifies that the information provided is believed to be true and correct, and that I/we agree to the Terms and Conditions as set out by the Guidelines as written by the Cadiz Rotary Club.I further understand that if I do not Electronically “Sign” this Request, then this Request will not be considered by the Cadiz Rotary Club.
Enter your name/Electronic Signature*
Verify your Name/Electronic Signature*

Youth & Senior Services Funds Request

Youth & Senior Services Funds Request Form

Applicant(s) receiving $1000 or more will be required to provide the Rotary Club of Cadiz with an itemized statement of how these funds were used.

If you answer “Other” please provide the following information in this same box.

Every application submitted to the Youth and Senior Services Committee must comply with all funding requirements of both the Rotary Club of Cadiz and Rotary International

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