Indication of Interest to Join

The District 5160 International Service Committee

District Resource Network

mm/dd/yyyy

Entry Date

First Name

Last Name

Mobile No.

Email Address

Rotary Club

District

What positions have you held in your Club, the District, or Zone?

Country or countries of special interest

Fluency in language(s)

Special skills, talents, or hobbies

Project Planning And Management Expertise Project Planning And Management ExpertiseGeneral Project ManagementPlanning Sustainable ProjectsCommunity AssessmentsMonitoring And Evaluation, AuditingFinancial Planning And Life-cycle CostingPartnership Management

Rotary grant experience Rotary grant experienceSecuring International Project PartnersRotary’s Grants Process And Grant WritingFundraisingHumanitarian Projects, Scholarships, Vocation Training TeamsHumanitarian projects, Scholarships, Vocation Training Teams

Please briefly describe your experience(s) in one or more of Rotary’s 6 Areas of Focus: • Peace and conflict prevention/resolution • Disease prevention and treatment • Water and sanitation • Maternal and child health • Basic education and literacy • Economic and community development

Please provide a paragraph summarizing your professional experience and skills.

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