ROTARY DISTRICT 5160

GLOBAL GRANT PROPOSAL

All information in this proposal must be complete in order for your project to be considered for a District Global Grant DDF Allocation. Please type inform then e-mail in PDF format.

  1. Project Title

1.1. What is the title of your project:

2. Sponsorship and Project Teams

(Each sponsoring club/district needs to form a project committee of at least three Rotarians and designate one primary contact to be responsible for all grant related correspondence with the District and Foundation).

2.1 Host Sponsor:

2.1.1Club Name:

2.1.2Club Number:

2.1.3District Number:

2.1.4Project Team Members

2.1.4.1Primary Contact

2.1.4.1.1Name:

2.1.4.1.2Contact Email Address:

2.1.4.1.3Contact Phone Number:

2.1.4.2Second Team Member

2.1.4.2.1Name:

2.1.4.2.2Contact Email Address:

2.1.4.2.3Contact Phone Number:

2.1.4.3Third Team Member

2.1.4.3.1Name:

2.1.4.3.2Contact Email Address:

2.1.4.3.3Contact Phone Number:

2.2 International Sponsor

2.1.5Club Name:

2.1.6Club Number:

2.1.7District Number:

2.1.8 Project Team Members

2.1.8.1Primary Contact

2.1.8.1.1Name:

2.1.8.1.2Contact Email Address

2.1.8.1.3Contact Phone Number

2.1.8.2Second Team Member

2.1.8.2.1Name:

2.1.8.2.2Contact Email Address

2.1.8.2.3Contact Phone Number

2.1.8.3Third Team Member

2.1.8.3.1Name:

2.1.8.3.2Contact Email Address

2.1.8.3.3Contact Phone Number

3.Club Qualifications

3.1 Has District 5160 Grant Management training been completed by required leadership of your club?

☐Yes ☐No

3.2 Has each Rotary Partner read and agree to the Club Memorandum of Understanding and submitted a copy signed by the club president and president-elect to their district?

☐Yes ☐No

3.3Has your club read the Grants Management Manual and understand that the Global Grant application process and any Grant resulting from your application will be governed by these guidelines?

☐YES ☐NO

  1. Objectives

4.1.Please provide a succinct statement of your objectives for this Global Grant Proposal:

4.2.What specific activities are to be undertaken to achieve these objectives:

4.3.Describe who will benefit from this Global Grant and how?

4.4.Where will this project take place? Please describe the benefiting community, including its location using any relevant geographic and demographic information.

4.5.When do you anticipate your project will take place and are there any considerations, other than receiving the Global Grant, that will prevent the project from proceeding?

4.6.Please provide your community assessment that identifies what community needs will your project address and how where those needs identified (see the Rotary Foundation: Community Assessment Tools (605C))

4.7.. How are these needs currently being addressed with local resources and/or government agencies?

5. Areas of Focus:

5.1 Global Grants must satisfy one or more of the following areas of focus. Please check the applicable area (s) of focus:

☐Promoting Peace

☐Fighting Disease

☐Providing Clean Water

☐Saving Mothers and Children

☐Supporting Education

☐Growing Local Economics

5.2 How will your project address the area(s) of focus goals?

5.3Detail what will be the project's impact on the community it serves:

5.4How will you measure your impact?

5.5 Describe how the project will be promoted in the community:

5.6 What provisions is the project team taking to enable the results of the project to be sustainable and what follow-up is planned to determine if these efforts at achieving sustainability are successful?

5.7 How will you promote Rotary awareness?

5.8List the names of all participating Rotary Clubs, Districts and other cooperating organizations:

No. / Organization / Role
1.
2.
3….

5.9 Please include a copy of the “Cooperating Organization Memorandum” executed by each of the participating organizations.

  1. Your Club’s History of Rotary Foundation Support

Provide the history of your Rotary Club’s per capita giving by Club members to the annual program fund and the Rotary Foundation by your Club for the past 3 years (this information can be found through accessing MyRotary.org and going to Rotary Club Central>Club View>Foundation Giving):

2013-2014 / 2014-2015 / 2015-2016
  1. Project Plan
  2. Provide a detailed plan to address how each aspect of the project will be carried out and how Rotary Foundation and RI policies will be followed
  3. The plan should document all tasks necessary to complete the activity;
  4. Who is responsible for each task?
  5. How funds will be spent; and,
  6. A timeline of activities.
  1. Budget:

A detailed, line-item budget needs to be submitted with the application. When determining the cost of goods and services, gather at least three separate bids or quotes to ensure that you receive the highest-quality goods and services at the best prices. When selecting a vendor, document the reason for your selection and keep records in your grant files of all bids submitted. During the competitive bidding process, identify any Rotarians associated with a selected vendor, practice impartiality, and ensure that theRotarian is not on the project committee.

8.1 Currency/Exchange Rate:

8.2 Name of local currency:

8.3 Current exchange rate:

8.4 Date exchange rate entered

8.5 Itemized Budget Details:
Budget Item / Supplier/Vendor / Amount in Local Currency / Amount in USD

8.6 Budget total in local currency:

8.7 Budget total in USD:

9. Financing:

99.1 DDF Contributions
Organization / DDF Contribution in USD
5160
9.2Cash Contributions from Sources other than District 5160 and the Rotary Foundation
Organization / Cash Amount in USD

9.3 Financing

Item / Source / USD
(a) / DDF Amount in USD
(b) / Rotarian Cash Amount in USD
( c) / Additional outside funding in USD
(d) / Requested Rotary Foundation (TRF) Match in USD
(e) / Total Financing in USD (Cash+DDF+Match)

10. Signatures and Affirmations

By inserting the names of the Primary Contact, the current President and President-elect of the sponsoring Club, the undersigned does hereby confirm that the above information is true and correct to the best of their understanding and that the Board of Directors of the Rotary Club of ______

______

has approved this project and the proposal for the above referenced Global Grant and that the undersigned has the authority as designated by said Board of Directors to complete this application and serve as primary contact.

Primary Contact: ______

Phone number:______

E-mail:______

Signature:______

Date:

Rotary Club of______

President 2016-2017

Signature:______

Date:______

Rotary Club of______

President-elect 2017-2018

Signature:______

Date:______

Please send the completed District 5160 Global Grants proposal PDF form to Steve Polcyn, Foundation Grants Chair, at