EmailMe Form - RCPB Community Grant Request 2019

Organization *

Contact Name *

First Last

Contact Phone Number *

### - ### - ####

Email *

Confirm

Web Site (if applicable)

This helps us understand your organization but is not required. Just use the following format: anynonprofit.org

Organization Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

If funded, make Check Payable to: *

Is the Organization a 501(c)(3)? *

YES

NO

If YES, is the tax status current? *

YES

NO

Briefly explain main objective or purpose of your ORGANIZATION: *

Amount of Request *

$ Dollars

Use whole dollars with no punctuation (i.e. 1000 not 1,000)

Briefly describe PURPOSE of grant/specific project to be funded. Please include
proposed budget and indicate other sources of funding, the amounts for each and whether they have already been secured or not. *

What are the BENEFITS of funding this grant request? How would this grant benefit the Kauai community? *

Rotary Sponsor *

Sponsor Phone *

### - ### - ####

Sponsor Email *