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FOR DISTRICT 5580 USE ONLY (once Grant is approved)

District Grant No. WCS -16.2.12 Date Approved: Click here to enter a date.

District Grant Subcommittee Chair Signature: __________________________________________

District Rotary Foundation Chair Signature: ___________________________________________--------------------------------------------------------------------------------------------------------------------------IMPORTANT: A project already started will not be eligible for World Community Servicefunds.

Explanation: Matching grants support the humanitarian service projects of Rotary Clubs and Districts.In this section, describe in detail the humanitarian need your project will address, the intent of the projectincluding info on the beneficiaries (how the project will benefit the community in need), how the projectwill be implemented, and how Rotarians will be directly involved in the project (involvement is requiredby both the Host Club and International Partnering Club).

The project is to Increase the capacity and ability of a rural Haitian village central, human waste,composting facility by installing a well; solar powered well pump and storage, and two accessorybuildings. The first building is to be used as the base for a water storage tank and two solar panels, andto house the solar pump controller in addition to the hand tools and supplies used in the compostoperation. The second is a shed to store vegetative materials that are used in the compost operation.Currently some of the existing composting bin space is used for vegetative storage and there is a need tostart utilizing those bins for their primary purpose of holding the compost piles. The addition of water atthe facility will greatly enhance the complex’s ability to properly clean and sanitize the individual 5 galcompost buckets that are used to hold and transport human waste from the residents in the village tothe central composting site, before returning them to the homes in the village. Right now water istransported from a river approx. ½ mile away. Water is also necessary to put on the compost piles tomaintain the right moisture levels in the piles for proper composting. The project will benefit the villageof Garde Saline by ensuring that proper sanitation practices are put into place in their village compostingoperation, enabling the village to get certified to start handling human waste composting fromneighboring villages and cities, increasing the capacity of this composting operation to serve morepeople in the area with the total effect of reducing disease and illness. The project will be primarilyimplemented by the NGO (The Faith Project) that is listed as the host organization and who initiallysecured the funding and supervised the construction of the village’s composting operation. The FaithProject will act as project coordinator and supervisor and has one member that lives in nearby Ft.Liberte that works approx. 3 days a week in Garde Saline supervising the NGO’s other projects/initiativesin the village. That member will contract with the local trades to get the well drilled and building’s built.The solar pump will be purchased in the US. On a trip to Garde Saline; several Rotarians andrepresentatives of The Faith Project will deliver the pump and misc. controls to the compost site, andwith local labor will install the pump and storage tank. The Rotarians will then participate in the startupof the pump and participate in the training necessary to teach the local villagers, assigned to run thepump, how to properly run and maintain the water system. On that trip pictures and documentationwill be acquired to do the follow up report.

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Please provide the name of the project site, the city or village, state or province, and country. Provide adetailed map of the area or provide GPS (Global Positioning Site) coordinates. List multiple locations, ifapplicable.

Project Site: Village Human Waste Composting SiteCity/Village: Garde SalineState/Province: Nord EstCountry: HaitiGPS coordinates (if no map is provided): 19 39’ 14” N & 71 52’ 26.5” W

Provide name of ownership of property that structure on which structure is to be built.Village of Garde Saline

Provide a blueprint/detailed drawing of the proposed structure as an attachment.

Provide the estimated length of time needed to complete the project. 3 Weeks

Describe how the benefiting community will maintain this structure or project (financing of maintenance,etc.) after grant funding has been fully expended and who will be responsible for sustainability of thestructure.

The Faith Project will maintain project and infrastructure for a number of years until the Village cancompletely take over financial responsibility. That responsibility is planned to be met by expanding thecompost operation into the City of Ft. Liberte (pop 77,000) that desperately needs a viable human wastedisposal system. The income of the citizens of Ft. Liberte is higher than village of Garde Saline and alarge number can afford to pay for the pickup and disposal service. The Faith Project is also helping theVillage of Garde Saline businesses grow and help the village develop a farming operation that theproceeds would go to maintaining and developing infrastructure for the village.

Describe specific activities of the Host and International Partners in implementing the project.

The Host partner is primarily responsible to collect bids, supervise design, supervise construction, and toprovide to the international partners all receipts and follow up reporting necessary. The internationalpartners will supervise the Host organization; review bids and design; send a delegation of Rotarians tohelp implement and observe the supervision of the project; take follow up reports and put them in aformat that can be presented to the District, Primary Club, and partner clubs.

What will the Rotarians who are members of the partner clubs do during the project? Please note thatfinancial support is not considered active involvement. (Refer to Matching Grant ApplicationInstructions for suggestions.)

Some will travel to Garde Saline to help implement the final stages of construction and observe theactivities of the Host organization, final stage contractors, and running of the solar pump. It will alsoobserve and inspect the operation of the community compost system. Some of the Rotarians willactively work on the final form of the follow up report and all will be involved in reporting the details ofthe project and present the follow up report to their respective clubs.

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Explanation: The Host Partner is the Club or District in the project country. A committee of at leastthree (3) Rotarians must be established to oversee the project. The primary project contact must be amember of the primary Club identified below. The Project Committee must be composed of membersof the sponsoring Rotary Club or NGO for Club-sponsored projects or District for District-sponsoredprojects. The committee members must be committed for the duration of the grant process. Pleaseprovide the primary address for all committee members, as all D5580 information will be sent to thisaddress. It is required that the primary contact (who receives all information from D5580) have an emailaddress to expedite communication.

Primary Rotary Club/District or NGO:Club: Name and Number and/or NGO: The Faith ProjectDistrict: Click here to enter text. Country: USA/Haiti

Primary Contact:Name: Dr. Cleantus JeanMember ID (if known): Click here to enter text.Club Name: The Faith ProjectPosition: Board MemberStreet Address: PO Box 97City/State or Province/Postal Code: Cap, Haitien, Haiti WIPhone: 50936834876 Email Address (Required): juncai2005@yahoo.ca

Project Contact #2:Name: Kathy AdamsMember ID (if known): Click here to enter text.Club Name: The Faith ProjectPosition: PresidentStreet Address: 1635 E Ponto Lake Rd NWCity/State or Province/Postal Code: Backus, MN 56435Phone: 218-682-2980 Email Address (Required): kathy.adams@tds.net

Project Contact #3:Name: Rick AdamsMember ID (if known): Click here to enter text.Club Name: The Faith Project, Inc.Position: TreasurerStreet Address: 1635 E Ponto Lake Rd NWCity/State or Province/Postal Code: Backus, MN 56435Phone: 218-682-3100 Email Address (Required): rickad@uslink.net

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Explanation: The International Partner is the Club or District outside the project country. In this case,the International Partner would be a Club in District 5580. A committee of at least three (3)Rotarians must be established to oversee the project. The primary contact must be a member of theprimary Club identified below. The project committee must be composed of members of the sponsoringRotary Club(s) for Club-sponsored projects or District-sponsored projects. The committee members mustbe committed for the duration of the grant process. Please provide the primary address for all committeemembers, as all D5580 information will be sent to this address. It is required that the primary contact(who receives all information from D5580) have an email address to expedite communication.

Primary Club/District:Club or District Name: Central Lakes (Pequot Lakes) Rotary Club Club ID Number: 28491District #: 5580 Country: ☒USA ☐CAN

Primary Contact:Name: Robert McLeanMember ID (if known): 3504441Club Name: Central Lakes (Pequot Lakes) Rotary ClubPosition: International Service ChairStreet Address: 25102 Norway LaneCity/State or Province/Postal Code: Nisswa, MN 56468Phone: 218-851-2303 Email Address (Required): robertm@hugllc.com

Project Contact #2:Name: Anthony LoosbrockMember ID (if known): 8405173Club Name: Brainerd Lakes SunrisePosition: MemberStreet Address: 16682 Jacksonville DriveCity/State or Province/Postal Code: Brainerd, MN 56401Phone: 218-855-1058 Email Address (Required): tonyl@deerwoodbank.com

Project Contact #3:Name: Matt KilianMember ID (if known): 8920761Club Name: BrainerdPosition: MemberStreet Address: 7985 Travis TrailCity/State or Province/Postal Code: Brainerd, MN 56401Phone: 320-267-1756 Email Address (Required): mpkilian@yahoo.com

Explanation: Official Exchange Rates can be found at:www.rotary.org/newsroom/downloadcenter/support/rates.html. Please use the most recent rate.

NOTE: The host club/district contributions are NOT matched by D5580.

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ITEMIZED BUDGET TO BE COMPLETED BELOW:

Budget Item # Units AmountEach

Subtotal

PU200 Lorentz Stainless Steel Pump W/Controller, surge protector, and Sensors

1 $2575.00 $2575.00

250 Watt Solar Panels

500 Gal Plastic Storage Tank

100’ Well

3m X 3m & 4.5m X 4m Accessory Sheds/Buildings

Security Fencing

2

1

1

1

1

$550.00

$400.00

$3000.00

$3668.00

900.00

$1100.00

$400.00

$3000.00

$3668.00

$900.00

Misc plumbing and Electrical Supplies and hookupLabor

1 $650.00 $650.00

Total $12,293.00

Subtotal all items in country currency: $NAExchange rate used US $1 = $NA

Explanation: Clearly list all financing in US dollars in the section below, noting which funds will becontributed in cash and which will be contributed from D5580 WCS funds. Use of WCS must beapproved by the Grants Subcommittee and authorized by the District Rotary Foundation Chair. The HostClub or District must provide at least $100 in cash, and it is highly recommended that they match asmuch as possible with “in kind” donations of sweat equity whenever possible.

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Note: A project bank account must be established in District 5580 or Host Country before WCS GrantFunds will be distributed. When established and total club/cash contributions have been deposited intothe account, the WCS Grant matching funds will be sent directly to the project bank account.

Host Club (Project Country) cash donation: $293.00D5580 Rotary Club(s) or District outside the Project Country:Cash (US$): $6000.00Subtotals, Cash: $$6293.00Total Cosponsor Contributions: $0Total Funds requested from D5580 WCS Fund: $6000.00

Additional outside funding not matched by WCS fund: $0Total Project Financing (Must equal budget): $12,293.00

Explanation: Before an application is submitted to D5580, project partners should discuss variousplanning details. The questions and statements below are a guide to aid project planning. Note that aRotary Club/District or Rotarian may not own anything purchased with grant funds.

Identify who will own equipment and maintain, operate and secure items purchased with grantfunds.

Will training in use and maintenance of technical equipment be provided? If so, who will providesuch training?

Is software necessary to operate any items? If so, has software been provided? Indicate what arrangements have been made for customs clearance if items will be purchased and

shipped from outside the project country. Provision of plumbing and electrification to structures where people live or work may be funded

with WCS funds. Have plumbing or electrification for equipment and appliances in existingbuildings (hospitals, schools, libraries, orphanages, etc.) been considered and funded?

Explanation: Authorizations ensure that both partners are aware of, and interested in, pursuing thedescribed project. By signing below, the current Club Presidents for Club-sponsored projects, and currentDistrict Grants Subcommittee Chair for District-sponsored projects, as well as the committee members,agree to the criteria listed and affirm their support of the projects.

All Rotary Clubs, Districts and Rotarians involved in this project are responsible to D5580 for theconduct of the project and its subsequent reporting. The signatures of all involved parties confirm thatthey understand and accept responsibility for the project. Parties may either sign this page or submit aseparate letter of commitment.

By signing below, we agree to the following:

All information contained in this Application is, to the best of our knowledge, true and accurate,and we intend to implement the project as presented in this Application.

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If a cooperating organization is involved, please make sure the following letters are included withthe Application:

Letter from the organization specifically stating its responsibilities, how it will interact withRotarians, and agreeing to cooperate in any financial review of the project.

Has the District Grants Subcommittee Chair of D5580 certified that the Application is completeand eligible?

*** Have the partners made copies of all documents for their files prior to submitting them toD5580?

*** Completed Applications should be sent to both of the following:

District 5580 Office: Diane Collins bigfish@uslink.net Grants Subcommittee Chair Blake Crosby bcrosby@far.midco.net

If you have any questions or concerns, please contact the Grants Subcommittee Chair.

Rev: June 2015

Additional Submittals WCS Grant Application

For Garde Saline Haiti Sanitation Project

Map of North East (Nord-Est) Haiti

Map of Area around Garde Saline

Map of Garde Saline showing Well Site

Photo of current wash facilities and composting Shed

Compost Site Plan

4X4.5 Shed Plan

3X3m Shed Plan