The Rotary Club of Chattanooga

Grant Application

 

Please complete the following short application and provide the requested attachments. (Mailing address - bottom of page 2)

 

 Name of Organization:  _______________________________________________________

Address:   __________________________________________________________________

                 __________________________________________________________________

Phone:      (_____)_________________                            Fax:  (_______)________________

Federal Tax I.D. No.:  ___________________________

Contact Person:  ________________________________  Title:  ______________________

 

1.      Is organization tax exempt under Section 501(c)3 of the Internal Revenue Code:

     ○ YES           ○  NO

2.      Is organization a United Way or Allied Arts Agency?        ○ YES                  ○  NO

3.      Organization Type:     ○ Religious      ○ Charitable         ○ Scientific          ○ Literary   

                                 ○ Educational   ○ Other

4.      Briefly state the purpose and/or mission of organization.  (Include Mission Statement, if available.)

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 Total Project Budget:  __________________        Amount Requested:  _________________

Project Starting Date:  __________________        Completion Date:     _________________

5.      Is this project to be coordinated with a collaborating organization?    ○ YES       ○  NO

            (If yes, attach letters of agreement from organization.)

6.      Briefly summarize the proposed project and its goals.  (Submit budget breakdown)

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 Please provide the following:

 1.      One- or Two-page letter describing the proposed project.

2.      List of current Board of Directors or Trustees.

3.      Copy of the Internal Revenue Service Letter of Determination indicating tax exempt status as a 501(c)3.

4.      For Schools ¾ The school has satisfied and continues to satisfy the applicable requirements of Sections 4.01 through 4.05 of Revenue Procedure 75-50.

               ○ YES       ○  NO

5.      Any brochures, pamphlets, etc., published for organization and/or specific project.

6.      Latest Financial Report and/or Annual Audit.

 

• No multiple year grants are considered
• No general operating, capital or endowment campaign grants will be considered
• No grants to individuals or private schools
• Only grants for projects in the Chattanooga area will be considered
• No grants for political, lobbying or designed to influence legislation nor grants for religious activities; however grants may be made to religious organizations for non-religious programs.

 

 We certify that the information contained herein is correct and complete.  We agree to keep accurate financial records for any funds that may be received and to use grant money strictly for the purposes detailed herein.

 

______________________________________          _______________________________

Signature of Authorized Officer                                   Title

 

Date: _____________________

 

The Rotary Club of Chattanooga

Attn:  Charity and Club Projects Committee

One Union Square, Suite 506

Chattanooga, TN  37402