HSC Youth Grant Final Report

Hemlock Semiconductor Youth Grant Final Report
Today's Date

MonthDayYear
Date
HSC Employee Name*

First NameLast Name
HSC Employee Email*
example@example.com
HSC Employee Phone*
Please enter a valid phone number.
In which county does your Youth Organization operate?*
Youth-Serving Organization Fiduciary Name*
Should be the name associated with the Tax ID number under which the youth group functions
Youth-Serving Organization Fiduciary Tax ID Number*
Youth-Serving Organization Fiduciary Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Youth Group / Team Name
If you are completing the volunteer hours to benefit the Youth-Serving Fiduciary Organization overall, you can skip this
Youth Group Main Contact Name (if this is not you as the HSC Employee)

First NameLast Name
Youth Group Main Contact E-Mail (if this is not you)
example@example.com
Youth Group Main Contact Phone (if this is not you)
Please enter a valid phone number.
Title of Volunteer Project *
Benefitting Charitable 501 (c)3, government or school name*
this is the organization for which your youth volunteered - NOT the Youth-Serving Organization or youth group itself
Physical Location of Volunteer Project *
Date of Project Start*

MonthDayYear
Date
Date of Project End*

MonthDayYear
Date
Number of K-12 Volunteers
If you are completing the hours yourself as the HSC Employee, skip this question
Number of K-12 Volunteer Hours
If you are completing the hours yourself as the HSC Employee, skip this question
Number of HSC Volunteers*
If you completed the required hours yourself without other employees, enter 1. If you chose to sponsor and not participate in the youth group volunteer project, enter 0.
Number of HSC Volunteer hours*
If you chose to sponsor and not participate in the youth group volunteer project, enter 0.

Volunteer Activity Description*
Specifically, what tasks did you and/or the K-12 Volunteers undertake to benefit the Charitable 501(c)3 Organization, school or governmental department?
How did this activity benefit, impact, and/or improve your county's community?*
How did this activity affect you and/or your youth individually and/or as a team?*
How will the youth group utilize these grant funds?*
Plan should match the proposal described in your Application

Please attach a minimum of 3 high-resolution JPG or PNG images here

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Does the youth organization have the necessary signed media releases or verbal permissions from the parent or guardian of all individual youth participating in the youth organization to be photographed or recorded?
Thank you so much for organizing and completing this project on behalf of the Great Lakes Bay Region. The Hemlock Semiconductor Youth Grant program was designed to teach our employees and/ or our area's youngsters the importance and the FUN possible in giving back to their hometown and to contribute to the communities in which they live.
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Hemlock Semiconductor Youth Grant Final Report