Grantee Name: 

Grantee Address: 

City: 

State: 

Telephone: 

Email of Contact Person: 

Name of Executive Director: 

Name of Contact Person: 

Purpose of Grant: 

Grant Period: 

Report Period: 

Grant Amount: 

Type of Grant: 

If you are reporting on a Project, Program, Endowment, Start-up or Capital Grant, please provide the following information:

1. Results:

a. List the original goals and objectives of the grant, and tell how they were met during this reporting period. Include the impact it made on your organization, community, and/or the population served.

b. In what ways did the actual project vary from your initial project plans? Describe how/why.

c. Describe any unanticipated outcomes, benefits or challenges encountered with this project, including current status on meeting any special terms of this grant. (For example, if this was a challenge grant, did you meet the challenge?)

2. Lessons Learned:

a. What are the most important results/lessons you have learned from this project?

b. How will you use what you have learned to inform future work?

c. What recommendations can you make to funders or others working in this field?

d. If you were to undertake this project again, what would you do differently?

3. Future Plans:

What is your plan for this project in the future? Briefly describe rationale for ongoing funding, expansion, replication or termination.

4. Financials:

a. Using the original budget included with your proposal, provide an itemized budget of actual expenses and income for the project for this period. Provide narrative on any variances of 10% or greater from the original project budget.

b. Include a detailed, complete accounting of how the specific grant dollars from this grantmaker were spent, including project financial statement if appropriate. Who else has funded this project and at what level?

If you are reporting on an operating grant, please provide the following information:

1. Describe organizational and/or programmatic achievements and setbacks during the grant period.

2. Describe significant board and/or staff changes during the grant period.

3. Explain how you measured the effectiveness of your activities against your goals and objectives. What have you learned? What would you do differently?

4. Please submit actual end-of-year income and expenses for the organization for the year in which the grant was used.