Connecticut Common Report Form

Post-Grant Common Report Form

Failure to submit this report may jeopardize future funding.Please submit only one copy.

Funder: The Community Foundation of Northwest Connecticut Date:______

Check One: Interim Report Final Report

SECTION A

Name of your organization:______

Name of executive director: ______

Organization Address: ______

Phone:______Fax:______Email: ______

Contact person:______Title:______

SECTION B

Grant amount: ______

General operating Project support Challenge grant  Capital/Endowment

Project/program name (if applicable):______

Grant Purpose:______

______

______

Project period (month/yr): __ /__ to __/__ Period covered by this report: __ / __ to __ /__

Signature of executive director:______Date:______

Typed/printed name and title:______

ADDITIONAL QUESTIONS

(maximum four pages)

SECTION C

1. Results

1. List the original goals and objectives of this project, and tell how they were met during this reporting period. Please include specific outcomes included in your grant application.
2. If this grant contains any special terms, conditions, or contingencies, please provide a status report (for example, in the case of a matching and/or challenge grant, how much money has been raised thus far, including sources of income?)
3. If your original project plans changed during the course of this project, please describe how and why.
4. What impact did the grant make on your organization, within your community, and for the population you are serving?
5. Describe any unanticipated benefits or challenges related to this project.
6. Describe how collaborative or cooperative efforts with individuals and/or organizations affected outcomes. This can relate to planning, implementing, funding, and/or evaluating this project/grant.

1. Lessons Learned

1. What are the most salient outcomes of this project and lessons learned?
2. How will you incorporate what you learned into future work?
3. Are there recommendations you can make to funders or others working in this field? If so, please describe.
4. If you were to undertake this project again, would you do anything differently? If yes, please explain.

3.Future Plans

1. What are your future plans, if any, for this project? Briefly describe rationale for ongoing funding, expansion, replication, or termination.

4.Public Relations

1. If possible, please relate a “human interest story” that illustrates this project’s success or impact.
2. If applicable, please attach marketing material related to this project (e.g., news items, brochures, letters of support, photographs, etc.)

SECTION D – FINANCIALS

1. Referencing the original project budget included with your application, please provide a detailed report of project-related expenses and income for this period. Explain any variances from the original project budget.
2. Include a detailed, complete accounting of how the grant funding was used.
3. What other sources and amounts of funding, if any, did you receive for this project?
4. If this is a general operating grant, please submit actual end-of-year income and expenses for your organization as they relate to this grant/project period.

SECTION E – COMMENTS

Please share your thoughts about ways in which the Foundation could provide additional support, as it relates to the funding process (excluding additional funding).