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Officers and Board of Directors 2017-2018

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Community Service - Funding Application
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 The Rotary Club of White River Junction

Community Service Project

The Rotary Year of 2016-2017

This form must be used. Additional sheets may be attached. 

Applicant:_________________________________________________________________________

 

Address:_______________________________Phone #:___________________________________

 

            ________________________________Email:_____________________________________

 

Project Title:______________________________Contact Person:___________________________

 

Address:     _______________________________________________________________________

 

Project Title:_______________________________________________________________________

 

Description: Use additional sheets if necessary.Include this cover sheet for App. to be complete

 

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

 

__________________________________________________________________________________

 

__________________________________________________________________________________

 

Budget:

 

     Request to Rotary: ______________________________________________________________

 

     Applicant's Contribution: _________________________________________________________

 

     In Kind Service: _________________________________________________________________

 

     Total: _________________________________________________________________________

 

Signed: ______________________________________________Date:________________________

                        Name and Title            

 

          Applications are to be mailed to 414 US Rt 5, Hartland, Vermont 05048-9691

         Please put White River Rotary Community Project on the envelope or subject line.

          Applications may be scanned and emailed to philip_hammond@comcast.net

 

Due Date: May 31, 2017 

   

 

A.M.Peisch & Company, LLP