Grant Report Form

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Date

- Month - Day Year
Date
Organization name
Contact person

First Name Last Name

Organization address

Organization phone

- Area Code Phone Number
Email
example@example.com
Grant number
Title of project or program
Using a single sentence, what is the purpose of the grant?
What are the dates of the project?
What was the dollar amount of the grant?
Have there been any changes to your organization's 501(c)(3) status since your request for this grant?

Yes No
If yes, please explain
What dates are covered by this report?
Check one

This is an interim report This is a final report
Which of the four grant categories does your grant fall into?

Building Our Livelihood Developing Our Talent Caring for Our People Enriching Our Community
Using one paragraph, what was your grant designed to accomplish?
Using the measures/indicators that you provided on your grant application, describe the outcome of your project.
Give one human interest story that helps illustrate the success of your project or program.
Attach any relevant materials that tell the story of your grant (news releases, brochures, photos, etc.)

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Cancel of
If you were to undertake this project or program again, would you do anything differently?
What recommendations do you have for others working in this area?
Financials: Please upload a PDF or Excel file detailing the expenses and income for your project.

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