Participant List Form

FINAL REPORT FORMS – PART 1

REFLECTION FORM

NEIGHBORHOOD GRANTS PROGRAM

FINAL REPORT INSTRUCTIONS

945 S. Main St., Suite 207 Salinas, CA 93901 Tel (831) 754-5880 Fax (831) 754-5876

Period Covered by this Reflection Form:

From: July 25, 2016 to May 26, 2017

Date this report is completed: ______

1. Name of Group:

2. Name of person completing this report:

3. Phone Number: E-mail:

NEIGHBORHOOD GRANTS PROGRAM

REFLECTION FORM

945 S. Main St., Suite 207 Salinas, CA 93901 Tel (831) 754-5880 Fax (831) 754-5876

1. Check the statement that best describes how your group feels about the progress of its project.

We are very satisfied with the progress of our project.

We are satisfied with the progress of our project.

We have had little progress with our project, because we have had some challenges.

We have not started our project, due to major implementation challenges.

2. Check the statement that best describes your group’s project.

Our group project has not changed since we submitted our NGP application.

Our project has changed a little, but we are progressing.

Our project is changing and we have not been able to make progress.

3. Check the statement that best describes how your group members feel about the workshops and individual assistance the Neighborhood Grants Program has given to your group.

The workshops and individual assistance have given us practical information that we have used to help us be successful with our project.

The workshops and individual assistance have been interesting, but we have used the information very little.

The workshops and individual assistance have not aided our project or group.

4. Reflect on the following statement with your group:

What recommendations or changes would you make to this program?

Please call (831) 754-5880 if you have any questions. Thank you for your time!

FINAL REPORT FORMS – PART 2

EXPENSE REPORT

SAMPLE EXPENSE REPORT FORM

Name of Group:

Name: Phone: Date:

Directions: Use the following form to submit your final expense report, receipts do not be in any specific order but please number each receipt on the upper right hand corner so that it corresponds with the receipts in column “Receipt Number”. In column number two, write the receipt date that the expense/purchase was made. In column number three, write down the name of the store, merchant, business, and/or individual where the expense/purchase was made. In column number four, briefly write what was purchased and what it was used for. In column number five, write down the total amount of the purchase (fees, taxes, shipping and handling are acceptable expenses).

*Please include copies of all receipts in attached envelope

1 2 3 4 5

Receipt Number / Receipt Date / Name of store, merchant, business, individual, etc. / Describe what the item(s) was used for. / Amount
1 / 1/5/2012 / County of Monterey / Filing fee for fictitious business name statement. / $37
2 / 1/10/2012 / The Salinas Californian / Filing fee for Public Notice. / $50
3 / 1/15/2012 / John Doe / Reimbursement for opening up bank account. / $100
4 / 2/7/2012 / Banner and Sign Company / 20 neighborhood watch signs for neighborhood watch committee. / $630.22
5 / 2/14/2012 / Art Supply Store / 50 Paint brushes, 10 isles, 2 drop cloths, paint, etc. for painting classes / $422.34
6 / 3/5/2012 / Food for Less / Water, fruit, coffee, coffee cups for monthly meeting. / $42.56
7 / 3/15/2012 / Monterey Peninsula Print Shop / 2,000 flyers for fundraising event. / $542.50
8 / 4/1/2012 / Play it Again Sports / 25 soccer uniforms (shirts and shorts) for girls soccer team / $1,085
9 / 4/11/2012 / Peninsula Childcare / Childcare for monthly guest speaker. / $50.00
10 / 5/10/2012 / Jane Smith / Mileage reimbursement for leadership training. (82 miles x 0.51 cents per mile) / $45.51
TOTAL EXPENSES / $3,005.13

EXPENSE REPORT FORM

Name of Group:

Name: Phone: Date:

*Please include copies of all receipts in attached envelope.

1 2 3 4 5

Receipt Number / Receipt Date / Name of store, merchant, business, individual, etc. / Describe what the item(s) was used for. / Amount

EXPENSE REPORT FORM

Name of Group:

Name: Phone: Date:

*Please include copies of all receipts in attached envelope.

1 2 3 4 5

Receipt Number / Receipt Date / Name of store, merchant, business, individual, etc. / Describe what the item(s) was used for. / Amount
TOTAL EXPENSES

FINAL REPORT FORMS – PART 3

PARTICIPANT & EVENT LIST FORMS

PARTICIPANT LIST FORM

Name: Phone: Date:

Name of Group:

Purpose: The purpose of this form is to provide the Neighborhood Grants Program a list of individuals who participated in your project.

Directions: Please fill out this form in pen or pencil to the best of your ability. Please include all of your group’s leaders and anyone else who participated in the project. If you do not have their information please indicate by writing n/a.

EXAMPLE

Name City Age Gender Language

(approximate) (male/female) (primary)

Name City Age Gender Language

(approximate) (male/female) (primary)

PARTICIPANT LIST FORM

Name: Phone: Date:

Name of Group:

Purpose: The purpose of this form is to provide the Neighborhood Grants Program a list of individuals who participated in your project.

EXAMPLE

Name City Age Gender Language

(approximate) (male/female) (primary)

Name City Age Gender Language

(approximate) (male/female) (primary)

PARTICIPANT LIST FORM

Name: Phone: Date:

Name of Group:

Purpose: The purpose of this form is to provide the Neighborhood Grants Program a list of individuals who participated in your project.

EXAMPLE

Name City Age Gender Language

(approximate) (male/female) (primary)

Name City Age Gender Language

(approximate) (male/female) (primary)

EVENT LIST FORM

Purpose: The purpose of this form is to provide the Neighborhood Grants Program a list of any large community event or activity that you or your group organized or participated in.

Did your group organize or participate in any large community event or activity with 50 or more people in attendance where you could not gather participant(s) contact information? YES or NO

EXAMPLE

Name or type of event Event date How many people attended?

FINAL REPORT FORMS – PART 4

SUCCESS STORY - OPTIONAL

Name: Phone: Date:

Name of Group:

Purpose: To share a unique success story made possible by your group’s neighborhood grant.

Directions: In 200 words or less, please tell us how the Neighborhood Grant Program helped someone from your group, be it a member or a participant.