The Rotary Club of Greater Lubbock, Texas

CONTRIBUTION REQUEST

Please print and complete this application using additional pages when necessary to fully answer the questions.  Submit 5 copies of this application and supplementary documentation requested below by mail  to Special Projects Committee, Greater Lubbock Rotary,  213 Zoar Ave., Lubbock, TX 79416 not later than December 31st.  Questions may be directed by email to GreaterLubbockRotary@yahoo.com

Organization Name:  Phone: 
Address: 
City:  State:  Zip Code: 
Submitted By:  Title:  

 

1. Primary purpose of organization: Include length of service and the number of persons served.

 

 

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2. State the amount of funds you are requesting: 

$ ________________ 
What is your total fundraising goal:  $ ________________ 
Please list other commitments/funds you have for this program.

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3. Describe the project/expenses intended to be supported if funds are received from the The Rotary Club of Greater Lubbock, Texas:

 

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4. What is the region of intended service? (Local Area, Group, City, County)

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5. Does your Organization have a Board of Directors?       Yes     No
If yes, please attach a list of members.
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6. Does your organization have a 501(c)(3) designation?    Yes     No
If yes, please provide a copy of official designation. 
(Having a 501(c)( 3) is not a requirement for receipt of a contribution.)
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7. Indicate how the Rotary Club of Greater Lubbock will receive recognition from our support:

 

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8. Are there items other than money that your organization might require? (Rotary is interested in projects that would benefit from Rotarian participation and may have "in kind" donation opportunities).

 

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9. Please include a project budget and your plan for evaluation of the completed project.
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10. Does this request have a special time requirement?     Yes      No 
If Yes, please explain: 

 

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