Grant Requests

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wh-4p-olTomball Rotary Club Grant Request

1. Name of Organization:

2. Contact Person and Phone Number:

3. Organization founding date:

4. 501(c)(3) certificate — please attach a copy

a. Priority will be given to 501(c)(3) charitable organizations, however consideration will be given to all that apply

5. Mission Statement:

6. Size of staff:

 a. Paid vs Unpaid

7. Number of people served on an annual basis:

8. Please provide list of organizations Board of Directors:

9. Budget Information: (provide copy of annual budget summary and itemized Income/Expense report)

United Way Funding ___%
Government Funding ___%
Contributions ___%
Fund Raising Events ___%
Foundation Grants ___%
Other ___%

10. Please summarize how a grant from the Tomball Rotary Club would be used to benefit your organization and the community.

 Please return your request with the information required to Tomball Rotary, Community Service Committee, P.O. Box 594, Tomball, TX 77377-0594.