C.C.H.D. GRANT –QUARTERLY REPORT FORM

 

 

FOR PERIOD:___________________________________DUE BY: _______

 

ORGANZIZATION:  GRANT # ________

 

            NAME:__________________________________________________________

 

            ADDRESS:_______________________________________________________

 

            CITY/TOWN:____________________________TELEPHONE:_____________

 

CONTACT   PERSON:________________________________________

 

 TOTAL C.C.H.D. GRANT: $__________; RECEIVED TO DATE: $_________

  1. HOW HAS MONEY BEEN EXPENDED? (Please itemize and explain, CCHD funds can only be used for items listed in your original budget.)

 

 

 

 

 

 

 

 

 

 

 

  1. List your objectives as stated in the original proposal.  Report accomplishments during the past quarter.  Please complete the form that follows, reporting on any meeting/action and the number of leaders who were present (April 2 / Action at the State Capitol to protest changes in food stamp regulations/500 people).

 

 

 

 

 

 

 

 

 

 

 

Date

Event Name

Number of People

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Briefly describe the activities by which the objectives were achieved.

 

 

 

 

 

 

 

 

 

 

 

  1. What problems or failure to achieve objectives have you encountered, and what do you plan to do to overcome them? (mention any alteration in goals or overall objectives of the project you may see as necessary.)

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Briefly list the objectives and activities to achieve them planned for the next quarter.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Please list any sources of additional funding applied for, and/or received, in the past quarter.  Please indicate how you have raised funds from your own members and how much was raised.

 

 

 

 

 

 

 

 

 

  1. What have you done to increase participation from Hispanic and African American persons in the work of your organization.  What results have you achieved?

 

 

 

 

 

 

 

 

 

  1. Any other comments?

 

 

 

 

 

                                                                        Signed___________________________

 

                                                                        Title_____________________________

 

                                                                        Date_____________________________

 Please save this report form as a template and e-mail your report each quarter  (Jan 1, April 1, July 1, Oct. 1) to:   PWallace@oua-adh.org.  Thanks.

CCHD