DISTRICT GRANT APPLICATION FORM

Date: ____________

Rotary Club of: ______________ ______

Rotary Club #:

Club President, RY 2023-2024: _____________ ______

Email address: ___________________

Name of Project: ____________________

Maximum District Grant allotment is Five Hundred Dollars, $500.00 (approximately Twenty Five
Thousand Pesos, P25,000.00).
All expenses over the allotment fund shall be for the account of the Club.

Provide a brief description of the project below:

(Please indicate- Venue, # of beneficiaries, approx. cost of materials / equipment’s or training

to arrive at total project cost.

Beneficiary: ____________________________________

Location Address: ____________________________________________________________

Target Date of Completion: ______________

Estimated Cost: ________

Total Project Cost: ____________ Grant Amount: ____________

Club Financed: ____________
Project Partners: __________________________________________________________

Proposed date of implementation: ________________ # of Rotarians involved: _______

Notes:
1. District Grant will be accepted only from qualified clubs with signed MOU.
2. Approved District Grant application funds will be released only to clubs with paid July SAR’s.
3. Payment will be in check payable to name of Rotary Club.
4. Deadline for reporting is thirty days after completion of project.
5. Please submit this form to SDG Carlos J. Chianpian at cjchianpian@yahoo.com.ph.

____________________ ______________________
Club TRF Committee Chair (2023-2024) Club President (2023-2024)
(Print name and Sign) (Print name and Sign)
Contact #: Contact #: