Grassroots Grant Final Report Form

Grassroots Subgrant Data Collection

Organizations who apply for and receive funding from the NCArts Grassroots Grants Funds, are required to fill out an end of grant report. Failure to submit a report, could prevent eligibility to apply in future years.
Organization Information
Organization Name*
Contact Name*

First NameLast Name
Contact Person's Title *
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email
example@example.com
Website
Sponsor/Fiscal Host Organization
If Applicable- If you have a 501c3 as a fiscal agent, please list here
EIN Number*
Organization or Fiscal Sponsor #
UEI Number
Organization or Sponsor #
Applicant Race*
Project Description
Project Name
Please provide a short description of your project using 25 words or less.
Project Start Date

MonthDayYear
Date
Project End Date

MonthDayYear
Date
Grassroots Grant Program Grant Amount*
Matching funds(required)*
Total project budget*
Total Project Budget
Participant Statistics - Total number of each
Participation and Audience Statistics
Total number of participants and audience members*
Out of the total participants, specify the number who are children and youth (Pre-K through secondary school students).*
Out of the total participants, specify the number who are artists.*
Excluding artists, what percentage of project participants were (should add up to 100%)
American Indian / Alaskan Native
Native Hawaiian / Pacific Islander
Black / African-American
Hispanic / Latino
White, not Hispanic
Asian
Select all races/ethnicities that make up the population, 25% or more, that benefit from the award.

Black / African-AmericanHispanic / LatinoWhite, not HispanicAsianAmerican Indian / Alaskan NativeAmerican Indian / Alaskan Native
Select all age ranges that make up the population, 25% or more, that benefit from the award. (required)

Children/Youth (0-18 years)Young Adults (19-24 years)Adults (25-64 years)Older Adults (65+ years)No single age group listed above made up more than 25% of the population directly benefited
Select all distinct groups that make up the population, 25% or more, that benefit from the award. (required)

Individuals with DisabilitiesIndividuals in InstitutionsIndividuals below the Poverty LineIndividuals with Limited English ProficiencyNo single age group listed above made up more than 25% of the population directly benefitedMilitary Veterans/Active Duty PersonnelYouth at RiskNo single distinct group listed above made up more than 25% of the population directly benefited
What percentage of artists in the funded project were (should add up to 100%)
American Indian / Alaskan Native
Native Hawaiian / Pacific Islander
Black / African-American
Hispanic / Latino
White, not Hispanic
Asian

Please list your multicultural artists and/or organizations that were supported with Grassroots funds and the amounts spent for each. In the first column indicate race using the letters A-Asian, B-Black/African American, H-Hispanic/Latino, N-American Indian, and P-Native Hawaiian/Pacific Islander, AND the Name of the artist or organization/business.

	Race - Name	Amount Spent
1
2
3
4
5
6
7
8
9
10
11
12

Education
Did 50% or more of this project's activities involve arts education; increasing knowledge and skills in the arts to grades Pre-K - 12?*
Project Narrative
Please provide a brief description of the project(s) funded: Limit 25 words per project
Has your organization ever received a Grassroots Arts Program subgrant before July 2023?*
What type of organization are you?*
Support Materials

Please submit materials to support the work you completed with this grant.
Attach copies of the letters and/or emails you sent to your State legislators notifying them of the project and your appreciation of this grant.  *

(Flyers with logos, News Releases with NC Arts mention, etc.
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Upload a PDF showing examples of marketing materials and other printed materials using the North Carolina Arts Council credit line and logo.  *

(Flyers with logos, News Releases with NC Arts mention, etc.
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Upload additional marketing, publicity, or promotional documentation here. *

(Flyers with logos, News Releases with NC Arts mention, etc.
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If you would like to share any links to videos, news articles, or websites that showcase this grant, provide the website URLs here (list link 1, link 2, link 3):
Upload any other important supportive documentation related to your grant that you wish to share with us.

(Flyers with logos, News Releases with NC Arts mention, etc.
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submit the list of artists by uploading a spread sheet or fill in the table below.

REQUIRED! - Artists name, their racial indicator, phone, email, role/medium, and amount paid
Data of Artists and Art Groups who participated
Should be Empty:

Grassroots Subgrant Data Collection

Organization Information

Project Description

Participation and Audience Statistics

Education

Support Materials

submit the list of artists by uploading a spread sheet or fill in the table below.