The Community Foundation Serving Boulder County

COMMON GRANT REPORT FORMAT

Due One Year After Grant Start Date

Note: This Grant Report Form is also available for download in Microsoft Word format; you can download it and fill it in on your own computer.

You are STRONGLY ENCOURAGED (but not required) to submit your completed Common Grant Report Form by e-mail. Send your Microsoft Word document as an attachment to grants@commfound.org

If you submit your Common Grant Report Form by U.S. mail, send your completed form to:

The Community Foundation Serving Boulder County
Attn: Carly Hare, Programs Director
1123 Spruce Street
Boulder, CO 80302

Name of organization reporting:	_______________________________________
	(Should be the same as on IRS Form 990)

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.

_________________________________________	__________
Signature of Executive Director or Authorized Board Officer	Date

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.