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
- Provide a brief description of the project, include the schools you worked with, discuss the specific activities, and participants used in the project.
- Describe how you evaluated the success of the project and is there anything you would have done differently.
- Attach any teacher feedback you received.
- Attach any images or links to video with captions of the project.
- 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.
- 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 / GradesTotal 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