Please Do Not Email the Word Template in Lieu of the Survey

Thank you for submitting your Marisla Final Report.

This is the Word version of the survey submission questions. We recommend that you prepare your responses in advance on this word template, save it and then copy and paste your answers into the online submission form. Please keep a copy of the completed word template for your records.

Please do not email the Word template in lieu of the survey.

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*indicates a required question

* 1. Organization name

* 2. Project (if applicable)

* 3. Amount Granted for Reporting Period

* 4. Month/Year Received

* 5. Primary contact name

* 6. Contact Email

* 7. Contact Phone

* 8. What program area did you apply under?

Environment

Human Services

Special Interests

Human Services and Special Projects Narrative

*9.OCCF Funded Project Description Summary(no more than 75 words):

*10.Summary of Accomplishments (no more than 150 words)

List the objectives as stated in the original proposal. Include a brief summary of the action taken and evaluation of each. Attach additional pages if needed.

11.Objective #1

Objective 1: Action: Evaluation:

*12.Objective #2

Objective 2: Action: Evaluation:

*13.Objective #3

Objective 3: Action: Evaluation: 13.

*14. Modification to Objectives (if needed). If there are any modifications to an objective (i.e. number of clients served, timeline, etc.) please explain in detail in the box below

*15. Narrative. Provide a brief description of the program for which you received funding and the impact of this funding to date. Be sure to include your successes as well as any obstacles encountered and how they were addressed.

Financial Report Summary

The budget section will follow the template below. It is recommended to draft your responses in excel using this format and then input each line item into the SurveyMonkey.

Please report on your entire program budget.
Only numerical data is allowed. Do not include periods or dollar signs. Put "0" and not "N/A".
Item / Budget / Actual / Balance
Salaries and Benefits
Consultants and Subcontractors
Travel
Conferences and Meetings
Rent
Office Equipment
Office Supplies, Postage, Telephone, Website
Communications
Indirect Costs (not to exceed 15%)
Other
Total Expenses

22 and 23 Budget and Actual Expenditures

Income Sources

24. Funding Source and Amount Stated in Proposal (E.g. Income Source Number #1: ABC Foundation, 20000)

Income Source #1

Income Source #2

Income Source #3

Income Source #4

Income Source #5

Income Source #6

Income Source #7

Income Source #8

Income Source #9

Income Source #10

Total Income Stated in Proposal

25. Actual Funding Source and Amount (E.g.Income Source Number #1: ABC Foundation, 10000)