Requesting Organization

     
 Your Name 

 
 Title

    
 Business: Address               

   
 Phone                                  Fax

 
 Email

Amount of funds requested (not to exceed $1,500) $  

Describe the specific use of the requested funds.  Please be mindful, in making your request, that although the Victoria Rotary Club welcomes grant request applications from all organizations, emphasis will be placed on funding requests from non-profit organizations for programs and services relating to youth education:
 

Your organization's Tax Identification Number:  

Give a brief description or your organization's mission and function: