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Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Organization name
Contact person
First Name
Last Name
Organization address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization phone
-
Area Code
Phone Number
Email
example@example.com
Grant number
Title of project or program
Using a single sentence, what is the purpose of the grant?
What are the dates of the project?
What was the dollar amount of the grant?
Have there been any changes to your organization's 501(c)(3) status since your request for this grant?
Yes
No
If yes, please explain
What dates are covered by this report?
Check one
This is an interim report
This is a final report
Which of the four grant categories does your grant fall into?
Building Our Livelihood
Developing Our Talent
Caring for Our People
Enriching Our Community
Indicate how the activities listed in your grant application were implemented and completed (if they were not, please explain)
List the three measurable goals indicated in the grant application. Were the goals accomplished? Please elaborate.
Give one human interest story that helps illustrate the success of your project or program.
Attach any relevant materials that tell the story of your grant (news releases, brochures, photos, etc.)
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If you were to undertake this project or program again, would you do anything differently?
What recommendations do you have for others working in this area?
Financials: Please upload a PDF or Excel file detailing the expenses and income for your project.
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