扶轮奖助金中文说明样

1、扶輪獎助金中文說明樣 (非正式表格)(此表格可由國際扶輪社網站下載 (141EN) Word檔)The Rotary Foundation (TRF)Major Matching Grants ApplicationFor grant requests of US$ 25,000 to US$ 150,000(適用美金$25,000-$150,000之間的申請表)Rotarians may use this application and attach additional pages as needed or may answer the questions below on blank p

2、aper, on the condition that the answers follow the same order as the application. Rotarians using the electronic version of the application will find that table cells expand automatically as information is added. Incomplete applications will be returned to the primary host partner with a brief expla

3、nation. See The Guide to Humanitarian Grants (144-EN) for instructions and eligibility and program requirements. (若表格空間不足, 各社可依照自己需要調整每個問題回答空間的大小, 只要不更改各項問題的順序, 請完整的填入資訊以免因為資訊不足而被退件 )Note: Applications for low-cost shelter and revolving loan projects and grant requests of US$25,001 or more have addi

4、tional requirements. See The Guide to Humanitarian Grants (144-EN), , or contact TRF staff for more information.1. PROJECT DESCRIPTION計畫內容1. What is the purpose of this project? Provide a brief description. (計畫目的為何? 簡單說明)2. How will it meet the needs of the community? (如何達到社區的需要?)3. H

5、ow will the host and international partners communicate and work together to implement this project? Please provide specific examples of activities. (主辦社與國外合作的社如何執行及溝通計畫? 請敘述活動的實例)2. COOPERATING ORGANIZATIONS 合作的機構 If this project involves a co-operating organisation: (如有合作的機構: )1. Provide the name

6、of the organisation below. (提供單位名稱)2. Attach a letter of participation from that organisation that specifically states its responsibilities, how it will interact with Rotarians in this project, and the organisations agreement to cooperate in any financial review of activities connected with the proj

7、ect. (附上該機構願加入計畫的責任與扶輪社的互動及財務的介入說明 )3. Attach a letter of endorsement of the organisation from the Rotarians in the project country. (主持計畫國之社友提出該機構的背書信)Name of organisation (機構名稱)Is the letter of participation from the organisations attached (Yes / No)是否有附上機構介入說明?Is the letter from the project

8、country Rotarians attached (Yes / No)是否有附上主持計畫國之社友背書信 3. RELATIONSHIP TO OTHER RI OR TRF PROJECTS (OPTIONAL) 與其他計畫的關係Is this project related to, or has it resulted from, other Rotary International or TRF projects? (Yes / No): If so, please identify those projects. (此計畫是否與其他國際扶輪或基金會的計畫相關? (是/否) 如是, 請

9、指出哪些計畫)Program 計畫Individuals Name and/or Project #人名/計畫號碼Program 計畫Individuals Name and/or Project # 人名/計畫號碼WCS Projects ExchangeGroup Study ExchangeIndividual GrantAmbassadorial Scholarships3-H GrantDistrict Simplified GrantMatching GrantOther:Could this project benefit from an international volunt

10、eer? (Yes / No)此計畫是否對國際義工有助益? (是/否) 4. PRIMARY HOST PARTNER IN THE PROJECT COUNTRY計畫主辦社List the club or district in the project country that assumes joint responsibility for the project.Rotary Club of社名Club ID # 社籍號碼 District 地區Country 國家 Project Committee: A committee of at least two Rotarians must

11、 be established by the primary host partner to oversee the project for its duration, even if the project continues into another Rotary Year.Primary Contact 主要聯絡人(must be a member of the above club/district)Additional Contact額外聯絡人Name 姓名NameMember ID # 社員辨識號碼Member ID #Rotary Club of 所屬社名Rotary Club

12、ofDistrict 地區DistrictPosition/title 職稱Position/titleE-mail 電子郵件信箱E-mailStreet address 住址Street addressCity / state /postal code 城市 區域號碼City / state /postal codeCountry 國家CountryTelephone 電話Home 家TelephoneHomeOffice 公OfficeFax 傳真FaxCellular 手機Cellular5. PRIMARY INTERNATIONAL PARTNER OUTSIDE THE PROJE

13、CT COUNTRY 國外社List the club or district outside the project country that assumes joint responsibility for the project.Rotary Club of社名Club ID # 社籍號碼 District 地區Country 國家 Primary Contact 主要聯絡人(must be a member of the above club/district)Additional Contact額外聯絡人Name 姓名NameMember ID # 社員辨識號碼Member ID #

14、Rotary Club of 所屬社名Rotary Club ofDistrict 地區DistrictPosition/title 職稱Position/titleE-mail 電子郵件信箱E-mailStreet address 住址Street addressCity / state /postal code 城市 區域號碼City / state /postal codeCountry 國家CountryTelephone 電話Home 家TelephoneHomeOffice 公OfficeFax 傳真FaxCellular 手機CellularProject Committee:

15、A committee of at least two Rotarians must be established by the primary host partner to oversee the project for its duration, even if the project continues into another Rotary Year.6. PROJECT BUDGET 計畫預算Include a complete itemised budget for the project and indicate which currency is used. Please a

16、nswer the questions provided about purchase of equipment, materials, or supplies. Use separate pages if necessary. Pro forma invoices, supplier price quotes, and/or other cost documentation may be required upon request.(列出計畫各項目之預算及貨幣單位, 包括購滿器具, 材料 可用其他表格附上)Item to be purchased 購買物品Name of supplier 廠

17、商名稱Cost 價錢總價(請聲明貨幣)Total (identify currency)$ 0.00換算美金匯率Exchange rate used相等於美金US$ EquivalentNote: To calculate the total automatically, place your cursor on the cell, click on Table, then Formula, then OK.7. PURCHASE OF EQUIPMENT 購買設備1. Who will own equipment and maintain, operate, and secure items

18、 purchased with grant funds? (Equipment cannot be owned by a Rotary Club or Rotarian) (誰將擁有,保養,使用及購買設備?) (社友及社不得擁有此設備)2. Is software necessary to operate any budget items? If so, has software been provided? (預算中購買的設備是否包括軟體的使用? 如是, 是否已有提供軟體?)3. Will training in use and maintenance of technical equipm

19、ent be provided? (是否提供設備維護及使用的訓練?)4. If budget items will be shipped, have arrangements been made for customs clearance? (如是進口品,是否有報關的安排?)8. PROPOSED FINANCING 財務建議If SHARE District Designated Funds (DDF) are part of the funding for this Major Matching Grant, either attach a letter(s) from the distr

20、ict Rotary Foundation committee (DRFC) chair(s) authorizing the use of those funds and specifying the amount or have the DRFC chair(s) authorize the use of the SHARE funds by signing below. Only the chair, on behalf of the DRFC, can authorize the use of SHARE DDF. Please list all financing and indic

21、ate cash or SHARE (DDF) amounts.Rotary Club / DistrictAmountContributing(US$) 捐款Cash /DDF 現金/DDFDRFC Chair Authorization 基金會主委簽字Rotary Club of 社名$0 CashDistrict # 地區$0 DDFRotary Club of 社名$0District # 地區$0DDFSub-total 合計$0.00Amount requested from TRF 基金會請款$0Additional funding from other sources其他來源$

22、0TOTAL 總計$0.00(Must be equal to budget cost) 必須與預算相同Note: To calculate the subtotal and total automatically, place your cursor in the correct cell, click on Table, then Formula, then OK.9. COMMUNITY NEEDS ASSESSMENT (FOR GRANT REQUESTSOF US$25 001 TO US$ 150 000) 社區需求評估(要求USD$25,000至USD$150,000)If y

23、our grant request is for US$ 25 001 or more, a community needs assessment must be included. This assessment should demonstrate how the proposed project: (如果您申請的金額超過USD$25,001 必附上需求評估及符合以下條件: )· Is viable and can be maintained by the benefiting community after grant funding has been fully expend

24、ed (可實行的,在獎助金使用完後受益社區還能夠繼續維持此申請計畫)· Involves the benefiting community, including its ownership of the project(受益社區及計畫擁有者必須參與計畫)Please refer to The Guide to Humanitarian Grants (144-EN) for additional information.Community needs assessment attached (Yes / No) 否有附上社區需求評估 (是/否)10. PARTNERSHIP AUTH

25、ORIZATION 合作的國外社授權All Rotary Clubs or districts involved in this project are responsible to The Rotary Foundation (TRF) for the conduct of the project and reporting on it. The partners signatures confirm that they understand and accept responsibility for the project. Partners may either sign this pa

26、ge or submit a separate letter of commitment.By signing below, we are agreeing to the following:· All information contained in this application is true and accurate, to the best of our knowledge.· This application meets all Matching Grant criteria as stated in The Guide to Humanitarian Gra

27、nts (144-EN).· We will ensure all cash contributions (as detailed in item 8) will be forwarded to TRF after Trustee approval of a Matching Grant.· We understand that if our club/district or our partner club/ district has overdue progress or final reports for any previously awarded Matching

28、 Grants, this application will be returned to the host partner.HOST PARTNER 主辦社INTERNATIONAL PARTNER 國外社Club President (if club-sponsored)社長Club President (if club-sponsored)社長District Grants Subcommittee Chair (if district-sponsored) 主委District Grants Subcommittee Chair (if district-sponsored)主委Nam

29、e姓名NameTitle職稱TitleRotary Club of 社名Rotary Club ofDistrict # 地區DistrictSignature簽名SignatureDate日期Date11. DISTRICT GRANTS SUBCOMMITTEE CHAIR CERTIFICATION 地區獎助金主委證明The Trustees strongly suggest that the district grants subcommittee chair from either the host or international district certify the appl

30、ication as complete. If the application is not complete or eligible, it will be returned to the host partner with a brief explanation.“On behalf of the committee, I hereby certify that to the best of my knowledge and ability this grant application is complete and meets all TRF guidelines.”District G

31、rants Sub-Committee Chair Signature主委簽名District 地區12. REPORTS 報告Although both partners are responsible for completing progress and final reports, the Trustees require that one partner take primary responsibility for submitting the reports to TRF.“By signing below, our club/district accepts primary r

32、eporting responsibility.”Signature簽名Rotary Club of 社名District地區13. COMPLETION CHECKLIST 核對主件Before submitting your Major Matching Grants Application, please take a moment to review this checklist. If you have any questions or concerns, please contact TRF staff (see below).¨ Are there written sp

33、onsorship confirmations from the club president(s)/district leadership who will be in office during the year of the funding request? (計畫是否獲社長及地區領導人支持?)¨ Does the project meet all grant policies and guidelines (see The Guide to Humanitarian Grants (144-EN) or the RI Web site at )?

34、 Does the project description clearly state how the project will assist those in need? (是否符合基金會申請條件?)¨ Have both the host and the international partner created committees to oversee the project? Are these individuals correctly listed on the application? (雙方是否設立主委委員會管理及監督計畫?是否正確在申請表格上列出?)¨

35、Have the responsibilities of the project country partner and international partner been outlined? Do they meet the requirements of a Matching Grant project? (雙方之責任是否清楚劃分?)¨ Are there written commitments (or signatures on section 10 of the application) from each primary project partner? If SHARE

36、 District Designated Funds (DDF) are used, the current district Rotary Foundation committee chair must provide a written confirmation authorizing use of DDF (or signature on section 8 of the application). (相關人士是否都簽字?)¨ Is a co-operating organization involved? If so, are there letters from 1) th

37、e organization, specifically stating its responsibilities, how it will work with Rotarians, and its agreement to co-operate with any financial review of the project; and 2) the primary host partner, indicating that it has knowledge of the organization and endorses the co-operative effort? (有合作機構時, 是否文件齊全?)¨ Is your project to build low-cost shelters? If yes, is a Low-Cost Shelter Agreement a