Grant Project/Program Evaluation Form

When your project has been completed, fill out this form and mail to the M & M Area Community Foundation as soon as possible.  Thank you.    

Date:                                                                                                                                                    Grant Number:

Organization:

Director:

Address:

Telephone:                                                                                                                                           

FAX:

Name of Person Filling Out This Form:

Name of Project:

Amount Received:  

Total Project Budget:                                                                             

Project Information

1.         Geographical Area Served by Project.

2.         Was this a:                             New Program                               Existing Program

3.         Target Population (Check all that apply):

                      All Ages                                                      Middle School Age Youth

                      Infants and children to 5 years                       High School Youth

                      Elementary Age Children                              Adults over 65 years

            If your project targets a special population for youth and seniors, please describe:

            (e.g. underinsured children, seniors with Alzheimer's Disease or etc.)

4.         Describe how you accomplished your program objectives and were your goals met?

5.         What were the overall strengths and/or weaknesses of the project?

6.         Did you have community or regional partners on this project?   

            No      

                Yes, specify the partners.

7.         Were matching funds used for this project? 

               No   

               Yes, how much and from whom?  Include in-kind donations.

8.         Will you be able to continue this project without further funding?     No      Yes (Explain)

9.         Funds were used for:      Personnel                    Equipment (List)                                      Brochures/Media (Enclose copies)

            Programming               Books/Videos/Computer Software        Other (Explain)

10.        Itemize income and expenses as they relate to this grant.

11.        Attach all publicity materials used to acknowledge grant.                   

             Attach additional sheets as needed.