COVID-19 Phase II Grant Report
Organization Name:
*
Organization Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Phone Number:
*
Please enter a valid phone number.
Reporter Name:
*
First Name
Last Name
Reporter Title:
*
Reporter Email:
*
example@example.com
Executive Director or CEO:
*
Organization's EIN:
*
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Program Name:
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Date Granted:
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-
Month
-
Day
Year
Date
Amount Granted:
*
in Dollars and Cents
What were the results of the program?
*
Be specific.
How many total clients were served?
*
How did this program impact your clients?
*
Have all grant dollars been expended?
*
YES
NO
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The following items MUST be provided as additional attachments to complete this report:
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Photos
Personal Stories or Testimony
File Upload
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Additional Comments:
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