769-EN—(614)
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
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.
CORPS MEMBERS
Please designate a primary RCC representative** to receive periodic email or text/SMS updates from RI. You may also provide
the names of up to ten additional RCC officers or members.
NAME
MALE
FEMALE
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EMAIL
MOBILE PHONE
(optional)
Each of the members listed above is a service-minded adult of good character and leadership potential who lives, works, or
studies in or near the corps community. Each of them understands and accepts the provisions of the Rotary Community Corps
guidelines and bylaws.
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:
Rotary Community Corps Organization Form
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
CORPS REPRESENTATIVE
DATE
SIGNATURE
PRESIDENT, PRIMARY SPONSOR CLUB
DATE
SIGNATURE
DISTRICT GOVERNOR
DATE
SIGNATURE
Scan and email the completed form to [email protected] or fax to +1-847-556-2182. Send two copies to your district
governor, who will keep one for district records and forward one to your regional RI office. Keep a third copy for corps records.
Rotary Community Corps Organization Form