2024 Spring Impact Grant Report
Agency Name
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Agency Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Name
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Email Address
*
example@example.com
Phone Number
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Please enter a valid phone number.
Program Information
What was the name of your program?
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Program Description
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What were the grant funds used for?
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Tell us an impact story from your program:
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Did you receive matching funds for this program? If so, please list what funds you received:
Did your program collaborate with other groups or agencies?
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Has there been any staff changes to your program in the last year?
Has there been any changes to your program in the last year?
Program Goals & Outcomes
What were the program goals listed on your original application?
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Did you achieve your program goals?
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How did you measure your achievements of your program goals?
Demographics Served
Total Number of People Served
What is the total number of households your program served last year?
What is the total number of individuals your program served last year?
County Data
Please select the counties your program serves
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Faulkner
Conway
Perry
Van Buren
Number of Individuals Served per County
Faulkner
Conway
Perry
Van Buren
Number of Individuals served by Age
Age 0-17
Age 18-59
Age 60 & Over
Number of Individuals Served by Ethnicity
Asian/Pacific Islander
African American
White/Caucasian
Other/Unknown
Native American
Signature
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