Name of Organization:

Address:

Telephone:

Lead person’s name and title:

Is your organization a registered 501(c)3? Yes No

Does your organization file a form 990? Yes  No If yes, please attach a copy.

Names and Titles of Board Members:

 Name                                Title                                         Volunteer?

 ____________________ _______________________  ____________

 ____________________ _______________________  ____________

 ____________________ _______________________  ____________

 ____________________ _______________________  ____________
 

Has your organization received funding from the Rotary Club of Castro Valley in the past?  If so, please list year(s), amount(s) and purpose(s).
 
 

Project/Program Information

Description of Project/Program (if necessary, attach additional page):
 
 
 
 

Individual responsible for project/program:

Number of individuals that will benefit from this funding:
 
 

A.  Total budget for project/program:      $ ____________
 
 

 B.  All sources of confirmed funding, including amounts:  $ ___________
  Source  Amount
 
 
 
 
 

 C.  All sources of other funding, including amounts:  $ ___________
  Source  Amount
 
 
 
 

 D.  Total of B + C      $ ____________
 
 

 E.  Balance needed (D - A)      $ ____________
 
 

Other comments (if necessary, attach additional page):
 
 
 
 
 
 
 

Note: The Castro Valley Rotary Club requests a report at the completion of the program/project, or, if the project/program is not finished, as of June 30 of the year following funding.  The report must include the number of individuals who benefitted from the program/project and the effectiveness of the program/project.  This report is required if funding is to be considered by the Castro Valley Rotary Club for this or any other future project/program.