District 5580District Simplified Grant Application

Please print or type all information and use additional sheets of paper if necessary. Incompleteapplications will not be considered.

See District Simplified Grants (DSG) 'CRITERIA & GUIDELINES' (attached) for instructions,eligibility, and program requirements.

FOR DISTRICT 5580 USE ONLY (once Grant isapproved)

District Grant No. J¥eS- /). .:3 .jb Date APp,.,~ed tJ /- /.9 '-.c?CJ /;;2-District Grant Subcommittee Chair Signature /;. ~. . ' ifDistrict Rotary Foundation Chair Signature _ ~ _" ,..1,1. PRO.JECT DESCRIPTION

Please describe the project, its location, its objectives, and howthey will be attained. Note: The projectcannot be started until the district grants subcommittee approves the District Simplified Grant Application.

1. .What is the purpose of this project? Provide a brief description. To provide weekend meals and'~shacksto grade school children who may not get meals at horne ... mostly low income families inthree school districts. Nutrition and hunger is an issue in our county,

2, How will it meet the needs of the community? Children with proper nutrition learn and do betterin school. .. this program also helps to fill the gap the food pantries may not be able to fill. Withhunger and literacy at the fore-front of what Rotary is all about...this is a perfect fit

3. How will the host and partner(s) (District 5580 Rotary Club(s) andlor others) communicate andwork together to implement this project? Please provide specific examples of activities. TheUnited Way was the original brain child for this project ... the Food 4 Thought program is workingon being self-sufficient. The volunteers purchase food which is nutritious and either can be heatedin a microwave or does not need to be heated at all. The food is delivered and volunteers,including teachers, put the food in the back packs when children are not around so that the

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recipients are anonymous. This is a collaboration between the United Way, the schools, Rotary and other community organizations.

Estimated project start date_______March. 2012________Estimated project completion date_May 2012__________________This is a yearly, continual program for the schools. Recipients may change each year. They are continually raising funds to keep the program active in the three school districts. This funding would be for the third quarter March –May 2012

If this project involves a cooperating organization, provide the name of the organization below, attaching a letter of participation from that organization that specifically states its responsibilities and how Rotarians will interact with the organization in the project. By signing this application, the Rotarian sponsors endorse the organization is reputable, responsible, registered with the project country, and acting within the laws of the project country. United Way/Food For Thought

Name the club that will coordinate principal funding for the project and that will assume responsibility for the project. Detroit Lakes Breakfast Rotary Project Contacts: Two Rotarians must be listed who will provide oversight and management of the project funds for the entire duration of the project, even if it continues into another Rotary year. Primary Contact Additional Contact Name Kathy Michaelson_____________________ Name Ryan Ritchie _________________________ Rotary position/title _Pres.____________________ Rotary position/title Int’l Service Chair___________ E-mail _modernk@arvig.net__________________ E-mail ritch014@umn.edu ____________________ Address 13125 West Lakes Sallie Dr Address1102 Summit Ave Street address Street address Detroit Lakes, MN Detroit Lakes, MN Town Town USA 56501 USA 56501 Country/postal code Country/postal code Telephone218-847-4951 612-750-0275

2. OTHER NON-ROTARY ORGANIZATIONS

3. ROTARY CLUB IN DISTRICT MAKING THE APPLICATION

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home home 218-847-7459 218-846-1900 office office _______________________________ __________________________________ cell cell 218-847-3199 218-847-5081 fax fax

Include a complete itemized budget for the entire project. Please use separate pages if necessary.

Since other organizations are assisting with this program, we are looking for matching funds of $500. This is an on-going yearly project. The money is spent entirely on nutritious meals and snacks…. The program delivers 200 bags per week to elementary schools in Detroit Lakes, Frazee, Vergas and Lake Park/Audubon. Cost per week is $800 with a monthly cost of $3200. Rotary would be covering about a week and a half of food during the month of March.

TOTAL$27,200 yearly

1. Who will own equipment, materials, or supplies? (Cannot be owned by a Rotary Club or Rotarian) Food for Thought and Lake Park, Frazee and Detroit Lakes Schools

2. Who will be responsible for maintenance, operating, and/or storage costs of the equipment/supplies? There really is no maintenance, operating or storage costs….any food that is stored is kept at the schools.

If equipment/supplies will be shipped (in the event of this being an international project), have arrangements been made for custom clearance? Please list all financing and indicate cash and District Simplified Grant money being requested. Primary Sponsor Rotary Club Amount Contributing Detroit Lakes Breakfast Rotary $_500.00 Other Rotary Clubs/Districts

4. PROJECT BUDGET

5. PURCHASE OF EQUIPMENT, MATERIALS, OR SUPPLIES

6. PROPOSED FINANCING

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9. ACTIVE ROTARIAN PARTICIPATION AND AUTHORIZATION

Sponsorship Authorization

·\lllh'ftar~ (Iubs and i)j lrit.:b 1Jl,,-\'I\l'd in tlH~prl'..i\!\.·! :11c· f( p<"n<;.lhk .. {;.. the DlS!fit.:l 5~XOl ouudauon(l!"illlt:-: 'Uht:llIIllllilh..·(' and ulllfnald~ tnlht:' Rot;tr) hlllllJ.lllon I..>t Rvl~1r.\ lntcruauonal 1~'iIIht:' couduct ot'the pn..'1CCi and h.-.rreponing 011 II. I he S!:~nafllr\.· ~II the houom otrhis page con lirrns Iii;)! the ...•poll .••Ur~understand and accept n.'spunsibilil) for the protect. "'pt'lll",i..\r!o ll1a~ \:lI!tr.:r ~ign this f'a~" I Ir 'iuhlll il .1

q~paralc Icncr \11' commiun-m

Pkd"'i\: liSl hdp\\ lile j.-h"·ll\'ilil.'~ ~fl..)Urcluh wil! \ll1dl.·11:tkl.~ dt.'J1\1111'\lrat!ug the active inv olvcrucru 11( ROl;ln;ws

IfllIl!,{ PI'O,I('ct,

B) signillg bdp\\. \H.~.rgrcc HI ill;: hllk)\\ illg.,U :\11 rnformation contained in this ~lpplit,;aliplI i", true and :1I..:L'lIr;llL'. f~t die he ...l pJ 1)1l!

10..11('1\\ Ict.i~1..·,Q I hi, <Il'l'liL'alllll1 01<.",,1, all District ~implili.:d (IratH criteria a~ :'1,tWO Iii j)hlricl

Silllpliti~d tirant:- (DS(j) CRI n:RI:\ &: (,1111)1:1 I'\ES,u '1 lie club has agn.'cd to under take thrs prnj.:c! :., an 'Klh il) of the dub,u We understand and will o.:,'mpl~, wuh the required Rotarian activities and reponing

rcquircmciu- as slale,1 ill Ihe Di<lri.-1 !->illlJ'lilicd (innlls i i)q ill'l I"IT RIA &C;IIIDFI INf~,

w We ~t:n:C' thai. ...•h\Hlid tilt! project tak~ 1I1<"It.' Ihall ..•i-, mnruhx to complete. uucriru reports\\ iil ht: xubrniucd l"\'cr~ ~i"\montl: .. li"(l!1l the til1h,~the granl I:' paid. :tnd fin:.!! n:J1orh \;11be provided 110 later litem 1\\\1 1111111111>allc! Ihe ",'lI1pieliPIl "flile prlli,'c\.

J Project- lIsing DS(, fund!'>must be L'{)mph:ll.·d within two C:~)yl'ar~ !""rwlt the unit: "ft=.ranl;1\11'1"0\'<11. Interim Rcpori-, nrc due e,,'1! six (6) moruh-, timing Ihe .leti, JI~ ,)1"111" l"ojeciand 1\ ithin 1"0 I~) moruh- nl ("mpkliq 1ol" the project. If the project cannot becornplctcd <I- expected \\ illr!n lk \\\",) car 11111" (rail"'. all [)SCi lund, 1\tL :--1 b,' returnedto the Divuict ~5~()"1 rca-urcr TOr~l'klJi,h III,' [)-;{j Cor,1Il1 I und.

10. AUTHORIZA. TION OF ROTARY CLUB'S FUNDS ' ' , " " i', ;

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11. COMPLETION CHECKLIST ,- ,

Before ,ubmining your Di~iric-t Sillll'litiLd (;rallt (U-;l.) "l'plicilllnn, please iakc u minute h'review this ched.li,t and make sure thai it i, complete. II H'lI ha\ c an:- '1"''''1<1\1' (11' C<I""<:II1--;,

please contact the di~Irir,.:l f!r~Ulb subcounniucc ch •.rir.

u Docs the project meet all DSG criteria?U Has the spon,oring club appointed 1\'0 l'On[;lCl, it) 0\ ersec the project?:.J .vre II1\'S('Inti.\ idunls c'OITC'<:!I:d li~led <>I1IIil,'npplicruion"..J h lilel'('.1 wriucn tunding coutinnation trrun the dub I'l'e,idcl1l(SI \\110 "ill be III "Cfj"c'

during the year "I' the: l'lIllding 1','qlH!,L'

:J I lave th~' rt2'sponsibilitlt':':> >.lfthe project "'pnll";,I,' bt:'t:n tlUliincd'.' Do Iht.:y tlll. ..'d till!requirements "fa DSG PI"jl.'l'I'.'

o i~there a \\ riucn commitment (t\r :-,ifoalill'l..· pll \..j.~\I..'ti~\nf) ofthl.' iJPpli\:~lIil.ln I rrom lll~

proje ...'l ~rl'll'Or'.J I' there a dl'laikd budget prm I\kd 1(1f Ihe ",aject'.:J "liler,':1 e(l,1 estimate 11\1111 the ,uPl'licl('llilr each item''..1 b a (Il0pera1ing organization involved? If.;n. i:-;. there a lcucr Iroru the org.inizauon.

\\ hich ~p~'l'in(ally swtc~ h()\\" the nr~ani.-:ation \\ ill \\ ork log~thcr ']Il{.1 htH\. J{otari:'lIb \\ illI'.: ;1\\ <lh cd ,.1I1d imeract?

J 11;1\C 1 ou outlined in detail h,w, ~ I'll plan 1" plli'lid/c' ilw project.'u l luvc Y(1U made copies of .:111 documents tor ~ ,)lI1 fih.·~ prior Ii.' -ubmiuing them h.l tIk"

Ji~tri,-'i grunts -ul» ..-ommiucc"

SOTE: Tile district grallfs ,\IIht'tJIIIIUilf('c will plnn Fr' review your apptirutiun a» .1'11111111,'

possih!e.

Send Ihe completed applicalinn 'IllII all :ltlachmcnh \'i:l cmail to:

Emai]: higlish II u~ljnl',IH'1

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q Is there a written commitment (or signature on Section 9 of the application) from the project sponsor?

q Is there a detailed budget provided for the project? q Is there a cost estimate from the supplier(s) for each item? q Is a cooperating organization involved? If so, is there a letter from the organization,

which specifically states how the organization will work together and how Rotarians will be involved and interact?

q Have you outlined in detail how you plan to publicize the project? q Have you made copies of all documents for your files prior to submitting them to the

district grants subcommittee? NOTE: The district grants subcommittee will plan to review your application as soon as possible.

Send the completed application and all attachments via email to:

Diane Collins, District 5580 Executive Secretary

Email: bigfish@uslink.net