Community Action and Pride Grants

CYCLE 30 FINAL GRANT REPORT FORM

Report Due No Later Than September 30, 2017

If you have any questions about this form, please contact CAP Program Staff at

Neighborhood Association (Grantee) Name:______

Name of Person Completing This Form: ______

Phone/Email: ______

Grant Amount: $______CAP Funding Cycle: ______30______

INSTRUCTIONS

Please complete all pages of this form and return it, with all required documentation, to:

United Neighborhoods of Santa Clara County (UNSCC)

Attn: CAP Grant Cycle 30

P.O. Box 90430

San Jose, CA 95109

Or

By email to

Hand Delivered Copies of the Final Report will not be Accepted!

Please use additional pages as necessary.

THIS FORM HAS FIVE PAGES! All pages must be included.

PART I

Briefly list the project(s) your group completed for CAP Grant Cycle 30.

1.  Provide the names of the neighborhood member(s) who attended the required training offered through the Neighborhood Development Center and which trainings they attended or include the certificate of completion.

AS PER THE CYCLE 30 MOU, EACH NEIGHBORHOOD ASSOCIATION MUST COMPLETE 1 TRAINING.

Name / Class attended
PART II

Please provide an accounting of the volunteer hours contributed to your grant-funded project(s) and any monetary match.

Volunteer Hours Match
Number of Volunteers / Total Number of Volunteer Hours worked / Total Volunteer Hours Matching Funds
(Total Number of Volunteer Hours Worked X $23.30)
Monetary or InKind Match
Description / Dollar Amount
Total Monetary Match
Total Neighborhood Match
Total Volunteer Hours Matching Funds +
Total Monetary Match
PART III

Please list each expenditure of grant money as indicated below. Be sure to attach receipts for all items purchased with grant funds.

(Use additional pages if necessary.)

Date Purchased Vendor Item Purchased $Amount

1.______

2. ______

3. ______

4. ______

5. ______

6. ______

7. ______

8. ______

9. ______

10. ______

TOTAL SPENT $______

Grant Funds Received (Your original grant amount) / $
Total Spent / $
Grant Funds Remaining (subtract total spent from original grant amount) / $

IMPORTANT: Any remaining funds must be returned in the form of a check made payable to: UNSCC. Mail your check along with a copy of this form and all your receipts to UNSCC, Attn: CAP Grant Cycle 30, PO Box 90430, San Jose, CA 95109. Questions:

Thank You!

CAP Grant Cycle 30 FINAL REPORT

(This page to be the coversheet for the Receipts for each activity).

Use 1 coversheet for each activity

Neighborhood Name: / Cycle: / 30
Activity: / Total Funding For Activity:
Number of Pages of Receipts for this Activity.

Copies of Receipts Only-Do not Sent Originals

RETAIN ORIGINAL RECEIPTS FOR YOUR RECORDS

Please review eligible and ineligible expenses in your MOU for Cycle 30 before submitting receipts.

CAP 30 1