Grant Partner Report Form

Grant Partner Report

Please complete this form to report on your funding progress.

* Indicates required field

Name of Grantee Organization *

Grant Report Type *

Name of Individual Submitting the Report *

First

Last

Title of Individual Submitting the Report *

Email *

Grant Number (Shown on grant agreement) *

Grant Amount *

Briefly describe the funded project and its overall purpose. *

Describe the population served by the project including geographic location, age, gender, numbers, or other descriptors. *

Have you met the goals and objectives as set forth in your grant proposal? *

Yes No Partially

Briefly describe the action steps or activities conducted by your organization to achieve project goals. *

Describe any changes you have seen in yourselves, your organization, or your community as a result of this project. *

Briefly describe how you measured or plan to measure outcomes for this project. *

Describe what long-term, lasting changes you hope this project will have. *

Provide an example or individual story that illustrates a significant impact your organization or program had on the lives of the individuals it served. *

Please provide a list of how you spent your grant funds. This does not have to be a detailed budget, simply give categories and amount breakdowns for your expenses. *

Have all your funds from the United Way grant been spent? *

Yes No

Release I hereby grant United Way of Perry County permission to use the infomration herein for purposes relating to the promotion of United Way of Perry County and its programs or events in its publications including newsletters, brochures, annual reports, displays, posters, videography, public service announcements, or any other form of literature or publicity including electronic such as on a website or Facebook. I hereby waive any right that I may have to inspect or approve the finished photo and release the United Way of Perry County from any and all claims, including claims for libel, arising out of the use of the photograph. *

Yes No

Electronic Signature *

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Grant Partner Report

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