In-Kind Contributions Reporting Form
Name of Contributor
*
Date of Contribution (future contribution dates are not allowed)
*
-
Month
-
Day
Year
Date
Matching Contribution?
Yes
Service Provider
*
Business-for-Profit
Churches/Faith-Based Organizations
Foundation/Philathropic
Government - Federal
Government - State
Government - Local
Individual (Community/Personal Time)
Local CBO/Civic Orgs (On Work Time)
School Districts/Educational Institutions
ParticipationFees/Fee Income
Resource Type
*
Cash
In-Kind
Cash Resource Description (complete only with Cash Resource)
Incubated/Emancipated Projects
Large-Scale Community Infrastructure
Local Dollar Investment
Other State/Federal Funding
Participation Fees
Cash Value
(only for Cash donation)
In-Kind Donations: Cash Value
(only for In-Kind donation)
Volunteer Hours
(only for In-Kind Donation)
Number of Volunteers
(only for In-Kind Donation)
Number Served
Expense Category
*
School Health Services (CC01)
Clinical Mental Health (CC02)
Educational Enrichment (CC03)
After School Not Daycare (CC04)
Day Care (CC05)
Crisis Intervention (CC06)
Early Childhood (CC07)
Employment Skills (CC08)
Family Support (CC09)
Transportation (CC11)
Professional Development (CC12)
Investment in Local Government (CC12)
Other (CC13)
Community & Neighborhood Dev. (CC14)
Program
*
After School Clubs (ASC)
Brother To Brother (B2B)
Bulldog Basketball (BBA)
Borrow My Angel (BMA)
Camp TK (CTK)
Community Collabs
Comm D&E
Continuum of Care (CoC)
CPO General
Crime Stoppers
Doling Landing
DYS
Early Childhood
FFN
Fulbright
Healthy Families
MBA
Mentor SGF
MFH-FSP
MHAT
MSOM
Neighborhood Based
Neighborhood Clean Ups
National Night Out (NNO)
New Day @ 809
Oakwood
OCH
One Door
Parent Cafe
PFS-Greene
PFS-Reg
Plymouth
Program Support Network
PRC
PRCOpioid
Prosper Springfield
Safe & Sober
SCLT
School Linked
Sisters-2-Sisters (S2S)
Social Work (SW)
SPIRIT
Tool Library
VITA
Wanna Play Catch (WPC)
Westport
Woodfield
Description
*
Core Results
Adults Working
Children and Youth Succeeding in School
Healthy Children And Families
Young Children Ready to Enter School
Children Safe in their Families and Families Safe in their Communities
Youth Prepared for Productive Adulthood
Prepared By
*
First Name
Last Name
E-mail
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Submit
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