Download a proposal form here

Rotary Club of Knoxville
Local Community Service – Project Proposal Form
Name and Description of the project:
___________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Which Rotary Area of Focus does this project address?
⃝
⃝
⃝
⃝
Basic Education and Literacy
Peace and Conflict Resolution
Cooperative Organization Name:
Organization Address:
Contact person:
Phone:
Maternal and Child Health
Water and Sanitation
⃝
⃝
Disease Prevention and Treatment
Economic and Community Development
______________________________________________________________________
Street
__________________________________________________________________
City, State Zip
__________________________________________________________________
Country
__________________________________________________________________
________________________________
______________________________________
Title:
_____________________________________
Email:
_____________________________________
FINANCIAL (GRANT) COMPONENT:
What is the duration of this project? (ie: one-time, _# of years, ongoing):
___________________________
What is the initial cost of this project? (Insert total cost of a one-time project): $__________________________
What is the total cost of this project? (If one-time, it should be same as above, if multiple years, it should be the annual cost x
number of years):
$____________________ (If initial year costs are different from subsequent years, please detail
here): _______________________________________________________________________________________________
What is the financial commitment/contribution from the cooperative organization?:
VOLUNTEER COMPONENT:
Is there a volunteer component to this project?
If so, please explain in detail:
⃝ By RCK
$__________________________
⃝ By Cooperating Organization
_________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Please include information about how many people will be touched by this project, its impacts, outcomes and community
benefits and/or anything that will help us understand why this project is more compelling than the many we have to choose
from: _______________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Name and email of person submitting this form:
RCK member who is willing to champion this project:
___________________________________________________________
____________________________________________________
(“Champion” means the person who voluntarily takes extraordinary interest in the adoption, implementation, and success of this project, but not necessarily
to chair the Local Community Service Committee)