CICF Common Grant Report

Organization Information

Name of Organization *

Contact Person's First Name *

Contact Person's Last Name *

Contact Person's Title or Role with Organization *

Email *

Phone Number *

Organization's Mission Statement *

Upload Organization's Preferred Logo *

Maximum file size: 268.44MB

Please upload a high-resolution print quality version of your logo.

Describe any significant changes that have occurred in your organization since the grant was awarded

Describe changes in the financial status of your organization since the grant was awarded

Describe the involvement of your board with the organization

Grant Information

Grant Number *

Grant/Project Title *

Type of Report *

Progress

Final

Award amount *

Date Awarded *

Briefly describe how grant funds were used *

Grant/Project Purpose - what was accomplished with this grant *

Describe who or what was impacted by the grant. If applicable, indicate the number and demographics of individuals that benefited from the grant *

Upload 3 or 4 photos that represent the grant's impact on your organization. *

Maximum file size: 268.44MB

Photos need to be high-resolution and print quality images.

Output Data

If applicable, how many people were served by this grant? (Unduplicated #)

Note: if people were not directly served by this grant, please leave this question blank.

What percentage of served is female?

What percentage of served is male?

What percentage of served is youth (0-17)?

What percentage of served is adult (18-65)?

What percentage of served is seniors (65+)?

What percentage of served is low-income? (qualifies for reduced/free lunch)

Please provide the percentages of racial and ethnic identity of those served with this grant.

What percentage of served identifies as Asian/Pacific Islander?

What percentage of served identifies as Black or African American?

What percentage of served identifies as White?

What percentage of served identifies as Hispanic or Latinx?

What percentage of served identifies as Native American/Alaska Native?

What percentage of served identifies mixed race?

Provide the specific geographic area you served with this grant. Please indicate if targeted specific neighborhoods, zipcodes, cities, etc.

What percentage of population was in Marion County?

If applicable, please list specific Marion County neighborhoods, zip codes, etc.

What percentage of population was in Hamilton County?

If applicable, please list specific Hamilton County neighborhoods, zip codes, etc.

What percentage of population was in other geographic areas outside of Marion and Hamilton counties?

If applicable, please list specific cities, zip codes, etc. from other areas outside of Marion and Hamilton counties

Describe the progress made toward your proposed goals and outcomes related to this specific grant. Please enter both proposed and actual outcomes.

First proposed outcome: *

First actual outcome: *

Second proposed outcome:

Second actual outcome:

Third proposed outcome:

Third actual outcome:

Describe any unexpected benefits or challenges that occurred during the term of the grant and discuss any significant lessons learned. Please include how you will use any lessons learned or results to improve your organization or program:

Describe the project implementation timeline

How did you recognize the grant?

If applicable, please include visual examples of how the grant was recognized.

Maximum file size: 268.44MB

Financial Accounting for the Grant

In each expense category below, provide a brief description of the actual project expense. Not all expense categories apply to all grants.

Expense Categories:

Employee Compensation, Benefits and Taxes

Description of Expenses (Employee Compensation, Benefits and Taxes)

Actual Expense (Employee Compensation, Benefits and Taxes)

Amount of grant used (Employee Compensation, Benefits and Taxes)

Professional Fees & Contracted Labor

Description of Expenses (Professional Fees & Contracted Labor)

Actual Expense (Professional Fees & Contracted Labor)

Amount of grant used (Professional Fees & Contracted Labor)

Professional Development

Description of Expenses (Professional Development)

Actual Expense (Professional Development)

Amount of grant used (Professional Development)

Printing & Publications

Description of Expenses (Printing & Publications)

Actual Expense (Printing & Publications)

Amount of grant used (Printing & Publications)

Supplies

Description of Expenses (Supplies)

Actual Expense (Supplies)

Amount of grant used (Supplies)

Marketing & Advertising

Description of Expenses (Marketing & Advertising)

Actual Expense (Marketing & Advertising)

Amount of grant used (Marketing & Advertising)

Travel & Transportation

Description of Expenses (Travel & Transportation)

Actual Expense (Travel & Transportation)

Amount of grant used (Travel & Transportation)

Equipment

Description of Expenses (Equipment)

Actual Expense (Equipment)

Amount of grant used (Equipment)

Other (specify)

Description of Expenses (Other)

Actual Expense (Other)

Amount of grant used (Other)

CICF Common Grant Report

This form cannot be saved or submitted until it is complete.

Organization Information

Grant Information

Output Data

Financial Accounting for the Grant

Expense Categories:

Employee Compensation, Benefits and Taxes

Professional Fees & Contracted Labor

Professional Development

Printing & Publications

Supplies

Marketing & Advertising

Travel & Transportation

Equipment

Other (specify)

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