Organization Name

Project Name

2015MISSION MAIN STREET GRANT CLOSEOUT REPORT

This report must be certified by the person requesting the grant and returned no later than July 31, 2016.

Be sure to keep a copy for your records. Return this document to the ECGRA offices upon completion. For technical assistance, please call Diane Kuvshinikov (814) 897-2690 or email .

Name of Organization:

Project Name:

Main Office/HQ Address:

Contact Person/Title:

Phone:

Email:

Grant Amount:

Section 1. Summary Narrative – Please attach a narrative summarizing your project. Please do not exceed two pages. Use the following questions as a guide to writing your summary:

  1. Briefly describe your fiscal year, including highlights, problems and changes made to your operations.
  1. Evaluate successes, shortcomings and unexpected outcomes as a result of the grant.
  1. Describe benefits to and impacts on your organization and the community through expenditure of the grant.
  1. In what ways did the funds help address the goals identified in your grant application?
  1. Did you form any new partnerships?
  1. Include letters, articles, before and after photos, press releases, testimonials, programs, etc.

Section 2. Financial Report – Please provide an overviewof income and expenditures for your project using the form below. Refer to the budget submitted with your application. Include a supporting income/expense financial report for your project.

A.Total Project Income
Income Source / Please specify details (e.g. name of funding source) / Amount
Federal Government / $
State Government / $
Local Government / $
Sponsorship / $
Other Income
(include your contribution) / $
Earned Income / e.g. box office, ticket/program/food sales, workshop fees, membership / $
ECGRA Grant / $
Total Project Income / $
  1. Total Expenditures

Expense Area / Please refer to details in your application. Add rows as needed. / Amount
Personnel/Benefits / $
Rentals / $
Facility Expense / $
Equipment / $
Supplies / $
Marketing / $
Contracted Services / $
Other / $
Total Project Expenses / $

Section 3. Collaboration – List the groups/partners involved in your project, if any.

Type of Group / Name of Group / # of Years in Partnership
Federal Government
State Government
Local Government
Private Sector
Nonprofit Sector

Section 4. Certification

I certify that the project described above was used for the approved purpose. To the best of my knowledge, the summary narrative and financial reports are true and fair.

Organization :______

Name:______Signature: ______

Position in organization:______Date:______

Please keep a copy of this report for your records.