2.   Requesting Organization: ___________________________ 

3.  Address: _________________________________________
      (Please provide the complete name and mailing address of your organization.
        If funding is approved, this is where the check will be mailed.)

4.  Person Making Request: __________________________
       Phone #: ________________________

5.  Name of Project: ___________________________________________

 
6.  Has this project been funded before by Glens Falls Rotary? 
      YES    NO    (circle one)

7. Please briefly describe the project, how Rotary funds would be used,
    and other sources of funding:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

 
8.   Please describe how the project fits into one of the Avenues of Rotary Service  (Club service (strengthening fellowship and functioning of the Club), Vocational service (serving others through our vocations while practicing high ethics), Community service (projects and activities to improve life in the community), and International service (to expand Rotary’s humanitarian reach to promote world understanding and peace): _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________ 
 
9. How could Glens Falls Rotarians personally assist in the implementation of the project? _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

10. Will this become an annual funding request?  YES  NO (circle one)

 
11. If funding is provided by Glens Falls Rotary, how will the Club and Rotary be acknowledged publicly for their contribution (signage, etc.)? _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

12. Amount Requested: __________________ 
  
Date Required: _____________________

Please mail this application to Rotary Club of Glens Falls
                                                     PO Box 4702
                                                    Queensbury, NY 12804