Community Service Project Form – Lake Chelan Rotary

Project Application Date*
Date Format: MM slash DD slash YYYY
Project Name*
Requested Project Completion Date*
Date Format: MM slash DD slash YYYY
Name of Sponsoring Rotarian*
First Last
Sponsoring Rotarians Email*
Project Recipients Name*
First Last
Project Recipients Phone Number*
Project Recipients Email*
Address of Project Location*
Street Address Address Line 2 City ZIP / Postal Code
Project Description*
Project Recipients Contribution*
- Financial ($)
- Materials
- Labour (Hrs)
Project Recipients Financial Contribution*
Project Recipients Material Contribution*
Project Recipients Labor Contribution (hrs.)*
Project Budget (Labor & Materials)*
Rotary Commitment ($)*
Name
This field is for validation purposes and should be left unchanged.