The Arts Council of Winston-Salem and Forsyth County

Wells Fargo Arts-In-Education Grant

2017-2018 Final Report Form

Final report forms must be completed and returned by May 4, 2018. Email all report forms to Dara Silver at . Organizations or individuals that fail to submit report forms will not be eligible for the upcoming grant cycle.

Contact Information

Name of Organization or Individual:______

Name of the Director or Manager of Organization: ______

Grant Applicant Contact: ______

Grant Applicant Contact Title: ______

Mailing Address: ______

City: ______State:______Zip: ______

County: ______

Telephone: ______E-mail Address: ______

Website: ______

Organization’s EIN or Individual’s SSN: ______

Fiscal Year: ______

Grant Data

Project Start Date: ______

Project End Date: ______

Amount Requested: ______

Amount Awarded: ______

Amount Spent: ______

Organization Income Last Year FY 2017: ______

Expenses FY 2017: ______

Project Evaluation & Budget

  1. Provide a brief description of the project, include the schools you worked with, discuss the specific activities, and participants used in the project.
  2. Describe how you evaluated the success of the project and is there anything you would have done differently.
  3. Attach any teacher feedback you received.
  4. Attach any images or links to video with captions of the project.
  5. Attach a copy of your advocacy letter to City Council and the County Commissioners. Letters should be sent by to local legislators by April 30,2018.
  6. Attach a budget sheet listing actual expenses and income for the project. Note, which items are in-kind.

Arts-In-Education Data by School

Provide the following data for each time you or your organization visited a school. If easier, you may attach an excel sheet of the following information with the same order of column headings.

Type of Program : Workshop (WS)Residency (RS)Performance(P)Other (O)

Date / School / Name of Program / Type of Program / Number of Students Reached / Number of Teachers Reached / Grades

Total Participation

Use realistic estimates where actual figures are not available. Use whole rounded percentage figures, not fractions.

______Paid Staff (full-time personnel)

______Paid Staff (part-time personnel)

______Volunteers

______Total number of Artists (paid and unpaid)

______Audience

______Total Participants

______Specify the number of Total Participants who were Youth

Audience/ Participant Ethnicity

% Racial/Ethnic Makeup (must total 100%)

______American Indian/ Alaska NativeBlack/African-American

______White, not hispanic Native Hawaiian/Pacific Islander

______Asian

______Hispanic/Latino

______TOTAL

Age

% Age Categories (may total less than 100% but not more)

______Child (pre-school/k-8)

______Secondary school student (grades 9-12)

______College/university student

______Senior citizen (age 65 and over)

______TOTAL