Grant Accountability Form
This form needs to be completed by all successful grant applicants within one year of receiving the grant money.
General & Contact Details
Name of Organisation (or Individual)
*
Contact Person
*
First Name
Last Name
Position in the Organisation
E.g. Treasurer, Accountant, Trustee, Representative
Email address
*
example@example.com
Cell phone number
*
Please enter your contact number
Landline number
Please enter your landline number
Funding Details
Grant amount received
*
Date Grant was received
-
Day
-
Month
Year
Date
Please explain what the grant was used for
*
Please complete the following breakdown of Grant Expenditure
*
Item
$ Amount
1
2
3
4
5
6
7
8
Total $ amount spent (this may be higher than the grant received)
Please upload evidence of expenditure (receipts, bank statements, wage records, etc.)
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This grant enabled to deliver the following benefits to the Community/ Organisation/ Goal (please list the key outcomes):
*
Please list outcomes
Was the support of the Golden Bay Community Trust acknowledged (e.g. in media, print, newsletter, posters etc.)?
*
Yes
No
Please upload evidence of the GBCT acknowledgement
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E-Signature
In submitting this grant accountability form, I declare that all of the information given herein is complete and true to the best of my knowledge.
Please sign here
*
Please verify that you are human
*
Submit
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