| Dates covered by this grant:
from ____________________ to
____________________ |
Executive Director: _________________________________________
|
Phone and email: ___________________________________________
|
|
Contact person/title/phone/email:
(If different from Executive Director)
_________________________________________________________
_________________________________________________________
|
Mailing Address: ___________________________________________
|
City/State/Zip: _____________________________________________
|
| Fax Number: __________________________
|
Project/Program Name: _____________________________________
|
Amount of Grant received: ___________________________________
|
Purpose of Grant: ________________________________________________________________
________________________________________________________________ |
Have there been any changes to
your organization’s IRS 501(c)(3) not-for-profit
status since you were awarded this grant? ________
If yes, please explain:
________________________________________________________________
________________________________________________________________
|
|
I hereby certify that the above and attached
statements are true and accurate.
|
| Please describe
the progress made toward the stated goals and objectives
related to this specific grant. |
| Describe what you learned
based on the results/outcomes you reported above and what,
if any, programmatic or organizational changes you will
make based on your results/outcomes. |
| What were the most significant
accomplishments of your organization this year? What were
the most difficult challenges faced this year? |
| What are the major needs of
the clients your organization serves? Please discuss any
emerging issues or unmet needs that you have noticed. |
| If you will be continuing
this program, what are the plans for sustaining or expanding
the program, including a future-funding plan? (For a general
operating grant, please answer in terms of the organization.)
If discontinuing the program, what factors led to this
decision? |
| You can attach additional pages if necessary. |