Medina Sunrise Rotary's Grant Application FormOur Mission"Committed to making a difference in the lives of children in our community and beyond through our time, talents, and treasures."Accepting grant applications for the 2024 - 2025 MSR fiscal yearPlease enable JavaScript in your browser to complete this form.Organization Information* All Fields Required Organization *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeContact Person *FirstLastPhone *Email *Website / URL *Organization's mission *Character limit: 200Tax ID Number *Is Organization Non-Profit / Tax Exempt? *YesNoOrganization's major funding sources *Character limit: 100Evidence of the organization's overall effectiveness *Character limit: 200Proposal SummaryPlease relate to Medina Sunrise Rotary’s Mission where appropriate Project name *Total Project Budget *Amount Requested from MSR *Project descriptionType of Request *CapitalCapacity-buildingOperatingProgramProjectOtherTotal budget for this program/project *Please use your organizational budget if this is a request for operating funds.Total number of people to be served under this program/project *Anticipated program/project start date *Anticipated program/project end date *LayoutRequested Date(s) for Receipt of Funds *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Describe how your organization will partner with other agencies and/or community collaborations *What is the challenge or need that will be addressed and how will the community benefit? *Goals, Outcomes and EvaluationBrief description of goals and objectives for program/project *What is the challenge or need that will be addressed and how will the community benefit? *If a funding is received, you will be required to report your progress toward these outcomes.Funding PlansList of other funders to whom this proposal has been and will be submitted *If this will be an ongoing program/project, describe plans for continued funding *Other InformationHow will Organization recognize this donation / grant from Medina Sunrise Rotary? *Any other information that is pertinent to this grant *SignaturesPerson Requesting Funds *Phone *Email *Signature *Clear SignatureSignature Name *Date *Submit Grant Application
