Charity/Organization Information
Date of Application:			Organization Name:
Street Address:			City:
Postal Code:			Telephone:
Charitable Registration #:			Contact Person:
Executive Director/Manager:			Contact Email:
State mission/goals of this organization:
Project Information
Name of Project:			Funding $ Required:
Is this amount the total required to complete this project? (Yes or No):
If no, provide a brief budget for the project showing other (potential and confirmed) sources of revenue and expenses.
Describe the purpose of this project, and show clearly how funding from the Rotary Club of Victoria (Harbourside) would be used?
Will you be working on this project in cooperation with other agencies or not-for-profit organizations? (Yes or No):
If yes, indicate with who and to what extent this cooperation will impact the success of this project.
Is this a New or Existing Project? New  Existing
Is this request for a one-time project, equipment purchase or capital (facilities/renovations) or ongoing operations? One-Time  Ongoing
Who will benefit most from this project? (Check all that apply) Youth  Families  Seniors  Adults
Duration of Project:
Start Date:			Completion Date:
Board of Directors Chair: