Artsnet, the Arts Council of SWLA

The Arts and Humanities Council of SWLA

P.O. Box 1437 Lake Charles, LA70602

337-439-2787/FAX 337-439-8009

Lake Charles Partnership Grants Program

Final Report Form

Dueby May 6, 2013

Grant #:

Project Title:

Grant Award Amount:

Grant Type:

Discipline:

Organization Name:

Organization Address:

Contact Person:

Daytime Phone:

______

1.Number of individuals who benefited directly from service(s): ______

2. Check the categories which in your estimation describe the predominate characteristics of a significant number (one fourth or more) of the individuals benefiting.

___ G General (Adult/General)___ E Mentally/Psychologically Impaired

___ N Native American/Alaskan___ D Hearing Impaired

___ A Asian/Pacific Islander___ Q Visually Impaired

___ B Black, not Hispanic___ P Otherwise Physically Impaired

___ H Hispanic___ I Institutionalized

___ W White, not Hispanic___ J Institutionalized/Correctional

___ C Child___ Y Secondary Student

___ U University/College Student___ F Female

___ S Senior Citizen___ V Veteran

3. Actual number of artists involved in the implementation of service(s) ______

4. Check the categories which in your estimation describe the predominate characteristics of one fourth or more of the artists involved.

___ G General (Adult/General)___ E Mentally/Psychologically Impaired

___ N Native American/Alaskan___ D Hearing Impaired

___ A Asian/Pacific Islander___ Q Visually Impaired

___ B Black, not Hispanic___ P Otherwise Physically Impaired

___ H Hispanic___ I Institutionalized

___ W White, not Hispanic___ J Institutionalized/Correctional

___ C Child___ Y Secondary Student

___ U University/College Student___ F Female

___ S Senior Citizen___ V Veteran

5. Narrative. Please answer the following questions as they relate to the completed activities or services supported by your Lake Charles Partnership Grant. Please use additional pages if necessary.

1. Describe the organization’s evaluation methods and results according to 1) artistic merit, 2) mission and Goals, 3) leadership of board or staff and 4) community outreach. Address any changes from the original grant application or grant agreement.

2. Describe the most successful undertaking of your organization that occurred during the grant period.

3. Does your organization require assistance or development in any of the following areas? Check all that apply.

___ Project Planning/Programming___ Volunteer Management

___ Artist Selection___ Marketing/PR/Advertising

___ Administration/Organizational Mgmt.___ Community Outreach

___ Budgeting/ Financial Management___ Board Development

___ Fundraising___ Audience Development/Arts Participation

___ Evaluation

Please explain your needs as they relate to any checked areas above.

Financial Summary

Total Cash Expenses (Columns A + B)______

Total Project Expenses (Columns A + B + C) ______

(including in-kind)

We, the undersigned, hereby certify that to the best of our knowledge and belief all the facts, figures and representations in this FINAL REPORT of the Lake Charles Partnership Grant Program are true and correct; that all programming activities and/or services were completed in accordance with the terms and conditions set forth in the Guidelines and Grant Agreement, and that all expenditures attributed to the Grant were in accordance with the approved budget for this Grant as substantiated by the attached documentation.

______

Chief Administrative OfficerProject Director

______

Printed Name & TitlePrinted Name & Title

______

DateDate

INSTRUCTIONS

Required Information for the Financial Summary

a. Expenses

Column A – Report actual amount of Lake Charles Partnership Grant spent in approved categories. Figures should be the same as those listed on Itemized Expenditures page.

Column B – List all other payments made by funds other than the Lake Charles Partnership Grant monies. (Applicant’s Cash).

Column C -0 Grantee’s In-Kind contributions.

b. Grantee’s Record of Itemized Expenditures (copy form as necessary)

Provide a complete accounting of those expenditures paid by funds from the Lake Charles Partnership Grant Program and the organization’s cash match by completing Grantee’s Record of Itemized Expenditures page and attaching all required substantiating documentation.

Column A – Identify expenditures by budget category letter from budget. (I.e., A. Duplicating/Printing, B. Equipment Rentals, C. Marketing/Publicity, etc.)

Column B – Provide the name of each payee and a description of services rendered (i.e., salary, printing.)

Column C – Enter the type and identification number of the documents attached showing verification of services you described in Column B. (i.e., Contracts, Invoices, Letters of Agreement.)

Column D – Enter the type and identification number of the document used to pay those listed. (i.e., cancelled checks or signed and dated cash receipts.)

Column E – Enter the amount of payment for each item listed in Column B and substantiated by documentation in Column C & D. Total all expenditures being sure to show the amount of the Grant already paid and the amount owed.

Required Attachments

In addition to those described above, please attach the following to the Final Report:

a. Samples of promotional materials containing credit statement.

b.Copies of printed articles, reviews, etc., of activity.

c. Glossy photographs, black and white or color, of activity.

Grantee’s Record of Itemized Expenses

Total Paid By Grantee ______

Total Amount of Grant Spent ______

Grant Payment received to date______

Balance of Grant Funds due ______