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Grantee Outcome Report

Submit Grantee Outcome Report using this form or download PDF version.

CONTACT INFORMATION

 

Project Name:
Organization Name:
Contact Name:
Title:
Street:
City:
State:
Zip:
Phone:
Email:
Website:
Tax ID Number:

 

ABOUT THE GRANT

 

Please recap briefly the goal(s) of this project:

Date grant received:
Amount of grant request:

Discuss the outcome(s) of the project, including whether you met your goal(s) (if not, why not) and who has benefitted:

Please provide a breakdown of grant expenditures and describe any significant variances as compared to the original grant request (i.e. expenses vs budget.):

What, if any, are the next steps for the project?  What are the associated funding requirements and potential sources of funds?

Upload Additional Information: