COVID-19 Relief Fund Grant REPORT
This is a cumulative report and will be requested periodically.
Organization Name
*
Must match 501(c)3 / FEIN
E-Mail Address
*
Confirmation Email
Current total # of Staff (jobs)
*
List all Jennings County COVID-19 Relief grant funds received to date (agreement date)
*
Rows
Grant#
Basic Needs Award Amount
Nonprofit Support Operations Award Amount
Nonprofit support COVID-19 Mitigation Award Amount
Check if spent
# Individuals Served during month
# Households served during month
April 2020
May 2020
June 2020
July 2020
Aug 2020
Sep 2020
Oct 2020
Nov 2020
Dec 2020
Jan 2021
Feb 2021
March 2021
April 2021
May 2021
June 2021
Total Amount Awarded to date
*
Actual Total # of social sector jobs retained through Nonprofit Support
*
Total # of individuals who access services, affordable housing, and/or financial products.
*
Supporting Documentation (for total amount spent to date)
*
Browse Files
Upload documentation to substantiate the total amount spent to date. This might include Charity Tracker reports, Utility Bills, Salary report, invoices for materials for plexiglass barriers, etc. Make sure your scanned documents are legible.
Cancel
of
Focus area of the organization
*
Outputs or outcomes from the funding
*
Share any stories that you have regarding the impact of these funds in our community, or how they have impacted your clients.
*
Breakdown
In the following section, combine all awards to date and break out how they were spent. They should match the total above.
Basic Needs - (direct client assistance) List projected #'s served (all months combined)
*
Rows
$ Amount
Served # Individuals
Served # Households
Housing
Utilities
Food
Shelter
Gas (for work)
Other (explain below)
TOTAL
Nonprofit Support - operations (all months combined)
*
Rows
$ Amount
Agency Rent
Agency Utilities (elect, gas, water, phone, internet)
Salaries
Insurance
Other (explain below)
TOTAL
Nonprofit Support - COVID-19 Mitigation / Reopening (all months combined)
*
Rows
$ Amount
Materials (lumber, plexi glass etc)
Supplies (Masks, hand sanitizer etc)
Equipment
Technology
Other (explain below)
TOTAL
Explain anything listed as "other".
Signature
*
*
First Name
Last Name
Click to submit
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