The Rotary Club of White River Junction
Community Service Project
The Rotary Year of 2022-2023
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. Please give a brief summary of your project!
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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, 2022
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