James Gibb Fund
Organisation Evaluation Form
Name of Parish/Church
*
Region that your organisation is located in
*
Please Select
Taranaki
Manawatu-Whanganui
Wellington-Wairarapa
Contact Name
*
First Name
Last Name
Contact Address
*
Street Address
Street Address Line 2
City
Region
Post Code
Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email
*
example@example.com
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Project Name
*
Year the grant was spent
Project report
*
Please type a precis of your project into this box (no more than 300 words and do not type "see attachments"). We require you to describe your project in your own words.
Supporting documentation
*
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Please attach any supporting documentation that you would like to provide
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Outcomes and Measures
Specify THREE outcomes you will use to measure the success of your project
*
Benefits
*
What lessons have your learned over the past year (e.g. special achievements, failures, future projections, trends, etc.) including what benefits did this project bring to your targeted community?
Unexpected Outcomes
*
Both positive and negative
Project completed?
*
Yes
No
Timing of project
*
If a multiple year project, please indicate future timelines and proposed milestones
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Total Grant Amount Provided
*
Breakdown of how the James Gibb Fund grant was used
*
Total Grant Amount Spent
*
Unspent Grant Balance (if any)
Reason for unspent grant money
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Authorised Persons
I/We confirm that the information in this grant evaluation form is correct and that our Parish/Church annual report will acknowledge that the project(s) received a grant from the James Gibb Fund (administered by Presbyterian Support Central).
Name 1
*
Signature 1
*
Name 2
*
NOTE: Two authorised persons MUST sign this application form
Signature 2
*
Date of Evaluation
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
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