Donation & Grant Request Form

Supporting local initiatives that build a stronger, healthier community.

Instructions: Complete all fields below, incomplete forms will not be considered. All requests are reviewed quarterly (March, June, September, December). Emergency or time-sensitive requests may be considered on a case-by-case basis.

Organization

Name

First Name

Last Name

Email

Phone

(###)

###

####

Name of Program or Project

Start Date

MM

DD

YYYY

Completion Date

MM

DD

YYYY

Project Description

Who will benefit and how?

Select the priorities this project aligns with

Estimated Total Project Cost

Amounted Requested from Fernie Rotary

If funded, how will the monies be used to support this project?

If funded by Fernie Rotary, we agree to attend a member meeting to share outcomes.

Yes

No

Maybe

Terms and Conditions Acceptance

I certify that the information provided is accurate and complete to the best of my knowledge. I understand that funds must be used for the purpose stated above and that Fernie Rotary may request a report or meeting attendance to share results. I accept that the Fernie Rotary Club reserves the right to decline or partially fund requests.

I Agree

Donation & Grant Request Form

Supporting local initiatives that build a stronger, healthier community.

Meeting Schedule