A9CC

Area 9 Cable Council, 17 Crawford Rd, Westport, CT 06880 www.a9cc.org

Cablevision Access Fund Grant – Report Form

Part 1) Project Information:

Town or School system:
Your Name:
E-mail Address:
Grant Amount:
Date of Report:
Page #:

Part 2) Items Purchased: (use a separate line for each item; e.g. if you received two vcr’s list each separately)

Item: / Make / Model / Serial Number / Cost
Sample: VCR / Panasonic / AG-1340 / 1KY2345678 / $185.95

Part 3) Explain any non-equipment expenditures or differences from amounts/items approved in grant application: (e.g. payments made to individuals for services; substitution for item requested on grant form)

Attach invoices from vendors for equipment and services or invoices, time sheets, 1099’s for operations grants.
A9CC

Area 9 Cable Council, 17 Crawford Rd, Westport, CT 06880 www.a9cc.org
Cablevision Access Grant Report Procedures

CV Access Grants:

1)  Complete part one. If you need to use more than one form, be sure to indicate the page number.

2)  Complete part two. You can erase the sample line. Use a second form if you had more than 14 items to report.

3)  If you had non-equipment expenditures or if the equipment or its cost was different from what was listed in your grant application, please explain in Part 3.

4)  Email a copy of the report to A9CC. (Include pdf or jpg copies of invoices for equipment and/or services or invoices, time sheets, 1099’s for operations grants.

[Note: Payments of more than $600/year to an individual must be reported to the IRS on a Form 1099. Consult your tax advisor.]

As per A9CC guidelines, E & G providers are not eligible for future grant funds until previous grant reports and prior year’s I-Net Logs are received by the A9CC.

Submission:

Educational / Governmental
Email: / Susan Morris

Cc: / Hal Levy

Cc:
Rev: 10/16