District Grants Reporting Form

District Grant Project Final Report Form

Name of Club(Required)

Project Title:(Required)

Which year was the District Grant Approved?(Required)

Project Description

1. Describe the project. What was done, when, and where did project activities take place?(Required)

2. How many people benefited from this project?(Required)

3. Who were the beneficiaries, how were they impacted by this project, and what humanitarian need was met?(Required)

Press Clippings

Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 30 MB.

Thank you letters from beneficiaries

Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 30 MB.

Photos of the Project(Required)

Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 30 MB.

4. How many Rotarians participated in the project?

5. What did they do? Please give at least two examples, not including financial support provided to the project.(Required)

Please use (+) sign to add new point each time.

6. If a cooperating organization was involved, what was its role?(Required)

Please use (+) sign in the right to add new point each time.

7. Financial Report

7.1 District Contribution (NPR)(Required)

equivalent to $1000.00

7.2 Club Contribution (NPR)(Required)

7.3 Other Sources of Contribution

S. No

Sources of Income

Amount (NPR)

(Please use (+) sign to add new point each time.)

Total Project Expenditures(Required)

Total income and expenditure must tally.

7.4 Letter of Commitment from the other Source of Income

Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 30 MB.

8. Please specify how you plan to enhance Rotary image in this project? We request you to include photographs showing the Rotary logo in the report?(Required)

9. Expenditures(Required)

S. No

Budget Items

Name of Supplier

Currency

Amount

(Please use (+) sign to add new point each time.)

9.1 Attach all the Bills of the Expenses

Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 30 MB.

Bills of expenses must be retained for 5 years

10. Authorization

By authorizing this report, We confirm that to the best of my knowledge these District Grant funds were spent only for eligible items in accordance with Trustee-approved guidelines, and that all of the information contained herein is true and accurate. I also understand that all photographs submitted in connection with this report will become the property of RI and will not be returned. I warrant that I own all rights in the photographs, including copyright, and hereby grant RI and TRF a royalty free irrevocable license to use the photographs now or at any time in the future, throughout the world in any manner it so chooses and in any medium now known or later developed. This includes the right to modify the photograph(s) as necessary in RI’s sole discretion. This also includes, without limitation, use on or in the web sites, magazines, brochures, pamphlets, exhibitions and any other promotional materials of RI and TRF.

10.1 President's Details

Name of the President(Required)

President's Contact No.(Required)

President's Email(Required)

10.2 Primary Contact Person's Details

Name of the Primary Contact(Required)

Primary Contact No.(Required)

Primary Contact's Email(Required)

Did you review the final report to ensure that the report is complete? Incomplete Report will not be considered.

Yes

Name

This field is for validation purposes and should be left unchanged.