Grant Evaluation Report

The Grant Evaluation Report is required as a condition of receiving a grant from the Community Foundation of Portage and District within 90 days of spending the grant funds. The report helps us learn about how the grant helped your organization succeed and how we can both meet our common goal of service to the community. We share the project information with our donor(s) & the community at large.

Reminders:

- The grant funds must be spent within 12 months from the date of approval.
- Receipts for all capital expenses must also be submitted with the Grant Evaluation Report.
- Please include digital photos illustrating the project funded by the grant.

Failure to abide by any conditions the CFPD may impose may result in the Grant Funds having to be paid back to the CFPD, and may impact your Organization’s eligibility to receive future Grants from the CFPD.

Comments

This field is for validation purposes and should be left unchanged.

Name of Grant Recipient(Required)

Project Name/Purpose(Required)

Address(Required)

Street Address City Postal Code

Email(Required)

Total Project Cost(Required)

Grant Amount Received(Required)

Project Income and Expenses

Important: You MUST include receipts or receipted invoices for all expenses (an invoice still showing a balance owing will not be accepted). You are responsible for ensuring vendors know you require a receipted invoice once purchases are made.

Project Income

CFPD Grant(Required)

Other

Name

Funds ($)

Your Contribution(Required)

Donations in Kind(Required)

Volunteer Services(Required)

Total Project Income(Required)

Project Expenditures

Project Expenditures(Required)

Item

Cost ($)

Note: for expenses for which you did not request CFPD funding, you may combine these into one line and are not required to list the provider(s) or submit receipts.

Total Expenditures

Grant Evaluation

1. What specific results or outcomes were achieved with your grant from CFPD? Were there any results you didn’t expect?(Required)

2. What were the actual benefits to the community from this project?(Required)

3. Provide a story CFPD can share publically to help illustrate the impact of your grant (whether to the community, your organization, or for an individual). Digital pictures related to the story and the grant must be included with this evaluation report.(Required)

Digital photos of the project(Required)

Drop files here or

Accepted file types: jpg, jpeg, png, Max. file size: 2 MB.

Upload receipts(Required)

Drop files here or

Max. file size: 2 MB.

Please enter the name and title of the person who we can attribute quotes to from any statements made in this report.

Full Name(Required)

Title(Required)

4. Publications and promotional materials relating to this project produced by grantees should carry an acknowledgement to CFPD, including our logo when possible. How was CFPD given recognition for the grant provided to your organization? Please send a copy of any published references to the grant along with this report.(Required)

Published References (if applicable)

Drop files here or

Accepted file types: doc, docx, pdf, xlsx, png, jpg, jpeg, Max. file size: 15 MB.

Acknowledgement by Grant Recipient

Two association/organization members (if applicable), with signing authority, must sign this form. By signing below, you are validating the accuracy of the information in this report and giving permission to CFPD to share the information and pictures publicly.

Name 1(Required)

Name 2(Required)

Position/Title 1(Required)

Position/Title 2(Required)

Signature 1(Required)

Signature 2(Required)

Date(Required)

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