PROJECT CARD Recommended for Use by Club Allocations Committee

JERUSALEM ROTARY CLUB

PROJECT CARD FORM [draft August 10, 2009]

[Note: Please fill in form responses using MS Word]

Name of the Project:__________________________

Name of the Beneficiary Agency:_________________

Name and Contact persons information of Beneficiary Agency: Name:_________

Mobile Phone:___________ Office Telephone:______________ Email:____________

Website:_________________

Location (address):____________________________________

Who Recommended: Request from Agency: ___ Recommendation of member:________

Date first presented to Allocation Committee Members:________

Type of Project: (e.g. Health/hunger, water/sanitation, literacy, other):

Local (Jerusalem)/District/International Project:_______________________

Project Description:

Objective(s):_______________________________

Who will benefit:_______________________: How many will benefit:____________

Specify how proposed allocation money will be used:________________________________________________________

Detailed Project Budget (specify where Allocation will be used):___________________________

Potential as Matching Grant: Yes:______ No:_________

Date first presented to Allocation Committee:____________________

Action of Committee: Recommended__________ Recommended conditionally (Explain) :_________________________Rejected:_____________________

Date Allocation Committee Recommendation presented to Club President:_____________

Date Presented to Board of Directors:________________________

Action of Board of Directors:

Approved for Allocation:_____________ Approved pending available funding:_____________ Requires further investigation:______________________

Rejected:________________________

Explain reason for decision:

Appendices

Please attach where available:

Beneficiary agency letter of request for funding

Detailed Project Description written by the agency:

Detailed Project Budget written by the agency, and

Other relevant supportive material.