FINAL REPORT - District Grant #

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Individual Project Report #

To be completed by Rotarians. Return this form with receipts to District Grants Committee.

Rotary Club:
Project Title:
Progress Report Final Report
Project Description

1. Briefly describe the project. What was done, when and where did project activities take place, and who were the beneficiaries?

AA
Areas of Focus
(1) Peace and conflict prevention/resolution (4) Maternal and child health
(2) Disease prevention and treatment (5) Basic education and literacy
(3) Water and sanitation (6) Economic and community development
2. How did the project address the goals for the area(s) of focus selected in the grant application?

Role of Partners

3. How many Rotarians participated in the project?What did they do? Please give at least two examples.

4. For International projects, what was the club, country, district and role of the international partner?

Role of Partners (continued)

5. If a cooperating organization was involved, what was its role?

Beneficiaries

6. How many non-Rotarians benefited from this project?

7. How did they benefit?

Financial Report (see next page)8. (Club must submit receipts for all expenditures with this report)

9. By signing this report, I confirm that to the best of my knowledge these District Grant funds were spent only for eligible items in accordance with Trustee-approved guidelines, and that all of the information contained herein is true and accurate. Receipts for all grant-funded expenditures have been provided to the district. I also understand that all photographs submitted in connection with this report will become the property of RI and will not be returned. I warrant that I own all rights in the photographs, including copyright, and hereby grant RI and TRF a royalty free irrevocable license to use the photographs now or at any time in the future, throughout the world in any manner it so chooses and in any medium now known or later developed. This includes the right to modify the photograph(s) as necessary in RI’s sole discretion. This also includes, without limitation, use on or in the web sites, magazines, brochures, pamphlets, exhibitions and any other promotional materials of RI and TRF.

Signature of Project Contact / Date:
Print name, Rotary title, and club

Mail to: LeeSa Cornelius, 709 Carolina Ave, Yadkinville NC 27055 –

PROPOSED EXPENSES / PROPOSED INCOME
Description / Amount / Contribution / Amount
Sponsor Club Contribution
Sponsor Club DDF Funds
Partner Club 1 Contribution
Partner Club 1 DDF Funds
Partner Club 2 Contribution
Partner Club 2 DDF Funds
Partner Club 3 Contribution
Partner Club 3 DDF Funds
Partner Club 4 Contribution
Partner Club 4 DDF Funds
Partner Club 5 Contribution
Partner Club 5 DDF Funds
Partner Club 6 Contribution
Partner Club 6 DDF Funds
Income from Other Sources
TOTAL / TOTAL

INCOME CANNOT EXCEED EXPENSES

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