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Grant Project Program Overview
Date
*
Grant Number:
*
Organization:
*
Director:
*
Address
*
Telephone
*
Fax:
Name of Person Filling Out This Form
*
Name of Project
*
Amount Received:
*
$
Dollars
Cents
Total Project Budget:
*
$
Dollars
Cents
Was this a
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New Program
Existing Program
Target Population (Check all that apply):
*
All Ages
Infants and Children to 5 years
Elementary Age Children
Middle School Age Youth
High School Youth
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 etc.)
Describe how you accomplished your program objectives and were your goals met?
*
Has this grant made a difference? If yes, please give us an example.
Did you have community or regional partners on this project?
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No
Yes, specify the partners.
Were matching funds used for this project?
*
No
Yes, how much and from whom? (include in-kind donations)
Will you be able to continue this project without further funding?
*
No
Yes (Explain)
Funds were used for:
*
Personnel
Equipment (List)
Brochures/Media (Enclose copies)
Programming
Books/Videos/Computer Software
Other (Explain)
File Upload
Itemize income and expenses as they relate to this grant and provide attached copies of documentations. (e.g. receipts)
*
File Upload
*
Attach all publicity materials used to acknowledge grant.
*
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