New Zealand Lottery Grants Board

NEW ZEALAND LOTTERY GRANTS BOARD
ACCOUNTABILITY REPORT

Lottery Health Research Committee

We need to know how lottery funding is being spent for the benefit of the community.
Could you please complete this form telling us how the community have benefited from this research grant. You do not need to repeat information in the form if this is contained in another document.
Please return it to the address shown on the letterhead

Name of Sponsoring Organisation:

Name of Principal Researcher:

Client number

Application number

Short title of research:

Purpose:

Amount:

Date grant approved:

Committee Members Comment:

______

Is this report: An Interim Report A Final Report 

Is your project finished?YES NO 

Have you fully spent your grant?YES NO 

What has the money been spent on?

Item:
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TOTAL / $
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If you have not spent all of the grant will you need the rest for the purpose approved?

YES NO 

If YES, when do you expect to have spent the rest of the grant?______

(date)

If this date is more than two years after you uplifted the grant, you will need to seek the committee's permission to retain the grant. Lottery Grants are expected to be spent within two years of being uplifted. You have agreed to return any monies which are unspent after two years. Please advise the reasons why you are seeking an extension.

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If NO: you can either return the balance to us now so that it can be distributed to other groups

oryou can apply for a change of purpose and/or time extension by briefly outlining the new purpose/s and/or project for which you wish to use the balance of the grant.

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We will advise you if this change of purpose and/or time extension is acceptable. You will need to submit a further report when the monies have been fully spent.

How has the grant helped you achieve your purpose? Please be specific. You should include:

the ways in which your research is benefiting from the grant, including any results
the ways in which the wider community is benefiting from the grant

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How have you publicised your grant?

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Please provide any other information you think is relevant e.g. publication of research findings, dissemination of results etc.

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Equipment (Please complete if your grant included funding for an item/s of equipment over $5,000)

Does your organisation still have the equipment?YES NO 

If not, what has been done with it?

…………………………………………………………………………………………

If you still have it, what is the equipment being used for? Please be specific. You should include:

how often is it used?
who uses it?
what is it used for?

(e.g. a microscope might be in daily use by your department for general use and used once a month by another department)

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Salary (Please complete if your grant included funding for salaries)

(This report should be completed by the worker's immediate supervisor or office holder).

What was the name of the worker/s employed under this grant?

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What have been the worker's/s main activities?

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How long was the worker/s employed under this grant? Please state:

number of months______

average number of hours per week______

How has the organisation gone about evaluating the worker's/s performance?

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What supervision and training did the worker/s receive?

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Declaration

We solemnly declare that all details contained in this report are true correct to the best of our knowledge and that we have the authority to provide this information and, if appropriate, to ask for a change of grant purpose and/or time extension on the organisation's behalf. (This report needs to be signed by the principal researcher, the head of the sponsoring organisation (e.g. Vice Chancellor) and the person in the sponsoring organisation, or Trust, that has responsibility for administering the grant (e.g. Finance Registrar).

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Name / ______
Name / ______
Name
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Signature / ______
Signature / ______
Signature
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Organisation / ______
Organisation / ______
Organisation
______
Position / ______
Position / ______
Position
______
Date / ______
Date / ______
Date

You should return the full completed Report to:

Secretary, New Zealand Lottery Grants Board

c/- Department of Internal Affairs

(at the address shown on the first page of this Agreement)