HARBORTOWN ROTARY  Duluth, Minnesota

COMMUNITY SERVICE PROJECT REQUEST FORM

 I.            PROJECT INFORMATION

            Project Name: _____________________________________________________

Sponsor (Club Member)______________________________________________

            Project Description:__________________________________________________

            Project Date: ________________

            Project Type:

            Cash Contribution ____________     “Hands-On” Project ________________

• If “Hands-On”, how many volunteers needed? ________________
• If “Hands-On”, what is the estimated $ cost for materials? _______

 II.            COMMITTEE REVIEW

              Approved? ________________ Rejected? ______________

·        If rejected, why?_____________________________________________

 III. PROJECT SUMMARY  (to be completed only if project is approved)

            Date of Project: ___________________________________________

            Project Captain: ___________________________________________

            $ Contributed:_____________________________________________

            “Hands-On” Projects:

·        Volunteers: __________________________________________________

·        No. of volunteer hours worked __________________________________

·        $ Required to complete project __________________________________

·        Contributions from others:        __________________________________

·        Estimated $ for donated equipment/supplies ________________________

            Project Summary : __________________________________________________

             Completion Date; ___________________________________________________

 Please attach all corresponding photos, notes, letters and receipts to report