769-EN—(520)

Rotary
Community
Corps

ROTARY COMMUNITY CORPS ORGANIZATION FORM

When received by Rotary International, this completed form will serve both as official notice that a new Rotary Community
Corps (RCC) has been organized and as official application for a certificate of organization. Please complete the form in full.

FULL NAME OF THE RCC DISTRICT STATE/PROVINCE, COUNTRY

Founded on:
DATE (DAY, MONTH, YEAR)

RCC language:   English   French   German   Italian   Japanese   Korean   Portuguese   Spanish

Full name and location — including city, state or province, and country — of the sponsor Rotary club(s)*

1. Primary sponsor club:

2.

3.

*Note that the sponsor Rotary club(s) must be located in the same district as the RCC.

RCC REPRESENTATIVE
Please designate a primary RCC representative to receive periodic email updates from RI. The sponsor club or current RCC
representative must provide RI with the contact information of the incoming RCC representative each year no later than
30 June. Failure to report the RCC representative to RI may result in the termination of the RCC.

Name:

Email:

The RCC representative, like each of the corp members, is a service-minded adult of good character and leadership potential
who lives, works, or studies in or near the corps community. The representative understands and accepts the provisions of the
Rotary Community Corps guidelines and bylaws. Corp members may create My Rotary accounts in order to connect with Rotary.
 By checking this box, we confirm that this RCC is being formed with at least 10 members.

QUESTIONS FOR THE SPONSOR CLUB(S)

1. Why are you sponsoring this RCC?
 To carry out a short-term project (active for up to two years)
 To carry out a long-term project (active for up to five years)
 For ongoing community improvement (will exist indefinitely)
 Other:

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 2. Briefly describe any specific service activities that the RCC plans to undertake.

3. Briefly describe how you will provide ongoing guidance and support to RCC members.

SIGNATURES
Your privacy is important to Rotary International and The Rotary Foundation (collectively, “Rotary”) and the personal data
you share with Rotary will only be used for official Rotary business. This means that the personal data you provide will primarily
be used for Rotary Community Corp purposes. You may receive information about Rotary Community Corp and other Rotary-
related information or events via email. The personal data you provide will be shared with your sponsor Rotary club and district
officers and their delegates. Personal data collected on this form is subject to Rotary’s Privacy Policy found at my.rotary.org/en/
privacy-policy.

CORPS REPRESENTATIVE DATE SIGNATURE

PRESIDENT, PRIMARY SPONSOR CLUB DATE SIGNATURE

Scan and email the completed form to rotarysupportcenter@rotary.org. Your club and corps should each keep a copy for their
records.

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