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Funding Application Form Applicant Details Name of applicant/organisation Address Contact person Contact e-mail Contact phone Regional focus Select...RotoruaBay or PlentyNew Zealand Funding Details Amount sought $ Provide details... Are you - An individual Select...YesNo - A community organisation Select...YesNo Provide details... Do you have charitable status? Select...YesNo Provide details... Have you - Sought other funding Select...YesNo - Contributed personally Select...YesNo - Prepared a budget Select...YesNo Provide details... If you are seeking only partial funding, what if the full target is not met? Provide details... Target benefits - Youth activities Select...YesNo - Enchance wellbeing Select...YesNo - Overcome social disabilities Select...YesNo - Healthier communities Select...YesNo - Active communities Select...YesNo - The Rotary brand Select...YesNo - Positive educational/literacy outcomes Select...YesNo Provide details... Bank Account Number Account Name Additional Detail Please provide any additional details

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