Impact Grant Report Impact Grant Report Community Impact Grant Recipients will use this form to report on project status to receive subsequent allocated funds. Step 1 of 6 16% Date Date Format: MM slash DD slash YYYY Name* First Last Email* Project Title*Organization Name* Number of individuals serviced by your project to date*Please enter a number from 0 to 10000.Population ServedPlease enter the approximate number of individuals your project is serving in each category . Please enter 0 if you do not serve that population or do not have the appropriate data.AgeYoung Children (0-9)*Pre-teens and teenagers (10-18)*Young Adults (19-29)*Adults (30-64)*Elderly (65+)*Race/ EthnicityAsian, Hawaiian, or Pacific Islander*Black or African American*American Indian or Alaska Native*White/ Non-Latino*White/ Latino*Other*Gender and Sexual OrientationMale*Female*Nonbinary/third gender*LGBTQ+*Heterosexual*Other DemographicsVeterans*Low-Income*Visually Impaired*Deaf/Hard of Hearing*Physically Disabled*Mentally or Cognitively disabled* What specific problems or needs in the community is this program addressing?*Please include any new need areas that have arisen as a result of this project, as well as what is required to address these new needs.Activities Conducted*Detail the activities conducted since receiving your grant funds.Frequency*How often do program activities occur?Do you collaborate with other organizations or groups?*yesnoin the futurePlease describe the collaboration that has taken place and if that other group(s) has provided funding for this project.*Please be specific on the additional funding sources for the project, especially if this grant allowed the leveraging of additional funding. How will you measure the success of this program?*Are you on track to meet your short- and long-term goals for this project.*How will you adjust the activities/resources needed if the results of the program are not in line with your goals?*What adjustments have you made already to help the program align with your goals? Financial Information*In the box below, please detail how funds distributed thus far have been used. Be specific.What activities are planned for the duration of this grant cycle?*Describe the activities planned using Community Impact Grant funds and their approximate cost for the second half of the year. Please attach any additional files, data, or images relevant to your Community Impact Grant. Drop files here or Accepted file types: doc, pdf, jpg, gif, png, . Tell us more...Use this space to share stories, ideas, questions, or things that you have learned up to this point in the year, with to regard your program/project.Signature*The information provided above is accurate to the best of my knowledge. I understand that failure to conduct my project/program as outlined in my application will result in a suspension of funding. I understand that failure to submit quarterly reports will result in a suspension of funding.NameThis field is for validation purposes and should be left unchanged.
