"SERVICE ABOVE SELF"

Meeting Wednesdays, 12:15 PM at The Greens of LeRoy

FUNDING REQUEST FORM

Annual deadline is March 31st

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(Note that it is the responsibility of the person submitting this application to also submit a written report to the Rotary Club of LeRoy within 30 days of completion of the project or within 12 months of the funding award, whichever is earlier. The report must include an accounting for the funds and a description of the outcome of the project)

By submitting this form I confirm that I am an authorized member of the organization declared on this form to submit a request for funding the project described. I have fully described and disclosed all relevant information pertaining to the proposed project. I agree that any funding received through this grant will adhere to the funding request policies as provided with such application. In the event that I am unable to provide requested documentation of such adherence or provide a written record of project status within a reasonable time, I agree to reimburse the Rotary Club of LeRoy for any undocumented or unauthorized expenditures. I also understand that, should this proposal be accepted, it is a one-time funding award and re-application will need to be made for any additional funding for same or different projects in subsequent years.