Note: This Grant
Report Form is also available for download in
Microsoft Word format; you can download it and fill
it in on your own computer.
You are STRONGLY ENCOURAGED (but
not required) to submit your completed Common Grant
Report Form by e-mail. Send your Microsoft Word
document as an attachment to
If you submit your Common Grant Report Form by U.S.
mail, send your completed form to:
The Community Foundation Serving Boulder County
Attn: Carly Hare, Programs Director
1123 Spruce Street
Boulder, CO 80302
| Name of organization
reporting: |
_______________________________________ |
| |
(Should
be the same as on IRS Form 990) |
Dates
covered by this grant:
from ____________________
to ____________________ |
Executive
Director: _________________________________________
|
Phone and email:
__________________________________________
|
| Contact
person/title/phone/email: (If
different from Executive Director)
_________________________________________________________
_________________________________________________________
|
Mailing Address:
___________________________________________
|
City/State/Zip:
_____________________________________________
|
| Fax
Number: __________________________
|
Project/Program
Name: _____________________________________
|
Amount
of Grant received:
___________________________________
|
Purpose
of Grant:
_____________________________________________________________
_____________________________________________________________ |
Have
there been any changes to your organization’s
IRS 501(c)(3) not-for-profit status since
you were awarded this grant? ________
If yes, please explain:
_____________________________________________________________
_____________________________________________________________
|
| I
hereby certify that the above and attached
statements are true and accurate.
|
| _________________________________________ |
__________ |
| Signature of Executive
Director or Authorized Board Officer |
Date |
| Please
describe the progress made toward the stated
goals and objectives related to this specific
grant. |
| Describe what
you learned based on the results/outcomes
you reported above and what, if any, programmatic
or organizational changes you will make based
on your results/outcomes. |
| What were the
most significant accomplishments of your organization
this year? What were the most difficult challenges
faced this year? |
| What are the major
needs of the clients your organization serves?
Please discuss any emerging issues or unmet
needs that you have noticed. |
| If you will be
continuing this program, what are the plans
for sustaining or expanding the program, including
a future-funding plan? (For a general operating
grant, please answer in terms of the organization.)
If discontinuing the program, what factors
led to this decision? |
| You can attach additional
pages if necessary. |
|
