Rochester Area Common Report Form

Please answer the following as completely and succinctly as possible.

Submit this report 12 months after receiving a grant unless the funder requires a different reporting schedule.

SECTION A (Complete Section A directly on this sheet.)

Organization completing report:

Address:

Contact Person: Phone:

Project Name:

Funder receiving report:

Grant Amount: Report Due Date:

This report covers the time period of ______________ (date) to ______________ (date).

Type of Support: ___Capital: __construction __renovation __equipment

___Endowment

___Program/Project

___General support for agency operations

___Other (describe)

Your signature:

Your title: Date:

SECTION B: Funder’s Notes (leave blank for funders to make notes here)

SECTION C

1) Use the attached form to compare your original budget with actual figures. Explain any variations from the original budget that are larger than 10%.

Answer items 2-5 in up to 2 pages:

2) Has this grant been instrumental in attracting additional support in the form of people, money, goods, services or publicity? If so, describe.

3) Review your logic model (or original plans, if no logic model exists for this effort) and:

a. Provide information about each outcome you indicated you would track.

b. Describe and explain any significant variances from the original plans outlined in the logic model.

4) Lessons Learned: What have you learned, e.g. about effective program strategies, realistic outcomes, usefulness of the logic model (include any feedback you want us to have about the logic model), on-going value of the project.

5) If applicable, summarize your current plans for the project’s future:

a. Programming envisioned

b. Financial support envisioned

c. Your ability to secure necessary support in the future