DRAFT Community Grant Accountablity Form

Name of Organisation

Name of Project/Activity

Name of Contact Person

Email

example@example.com

Phone

Area Code Phone Number

Postal Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Did the project/activity take place

If yes please answer the following questions, if no please go to section titled "Return of Funds'

Were the funds used in the way you outlined in your application

If no, please explain what they were used for in 50 words or less

Which of the wellbeing's did your project/activity contribute towards (choose as many as applicable)

Social Economic Environment Cultural

In 500 words or less briefly explain

How the grant was of benefit to the community
The actual (or estimated) number of people involves
How successful was the project
Was there any part of the project that could have gone better
How was Council acknowledged as the funder?

Explanation

Upload any photos, newspaper articles or pamphlets

Please show the expenditure on the project, including your contribution

	Project Costs	Amount (excluding GST)









Total

Upload a final summary of expenditure and income report or final budget

Upload all relevant invoices pertaining to the funding tagged for this grant by Council.

If you didn't spend the grant or only partially spent the grant please complete this section. Staff will be in contact to explain how to return the funds.

Choose on of the following

Full Return of funds Partial Return of funds

Type a question

The project/activity didn't take place The estimated and actual cost differed Other

In 50 words or less please explain the why the project/activity did not take place

Accountability Form for Community Grants

Detail of Expenditure

Return of Funds