Year End Grant Report

Partner Agency Year End Grant Report – Year Two

GRANT CYCLE 2016-2018 Report Due Date: June 1, 2018

Please complete the following form. You may need to refer to the below attachments. Please be sure to answer all questions and submit required signatures and attachments.

If you have any questions when completing the report, please contact:

Keri Stark, Director of Community Impact

Budget Attachment Example

Outcome Success Story Attachment

Agency Name *

Agency Phone Number *

Agency Contact Person *

Agency Contact Email Address *

Amount of Grant *

Using the original logic model from your proposal, please answer the following: *

A. Describe the project activities you were able to complete. If funding was used for operational costs, please identify how funding supported work of the organization overall. B. Describe the activities you may not have been able to complete and why. C. Describe the specific outputs/outcomes of this project, including the processes used to measure. D. Describe how the community is different because of these outputs/outcomes.

Statistical Information *

Describe how the community is different because of the services you provide (please support with statistics)? Include number of people served and an update of the unmet need. Please use the grant period 7/1/2016-6/30/2018

Successes *

Please identify 3 successes of the program/service funded by United Way. Please be specific and provide statistics when applicable.

Challenges *

If applicable, please identify any challenges you have experienced and how you overcame or will overcome these challenges.

Sustainability *

Tell us about your efforts to sustain the program/services funded by United Way. (Additional funding partners, your funding plan, etc.)

Collaboration Statement *

List organizations (non profits, schools, government, business, etc.) with which you are collaborating on the program/project

Budget Report Attachment *

Files must be less than 10 MB.
Allowed file types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit tar zip.

Outcome Success Story Attachment *

Files must be less than 10 MB.
Allowed file types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit tar zip.

PERSON COMPLETING THIS REPORT *

My typed name above shall have the same force and effects as my written signature.

EXECUTIVE DIRECTOR OR CEO (Print Name) * *

My typed name above shall have the same force and effects as my written signature.

DATE *

Year End Grant Report

Search form