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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!
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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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