Evaluation Report

Please let us know how the funds we granted were used.

Name of Organization *

Project Title *

Grant Amount *

Report Submitted By *

Email *

Phone *

(###) ###-####

Approximately how many individuals were served by this grant in the past year? *

What geographical areas were served by your project? *

Did your project address a need or a problem intented in your grant application? *

What problem or need was addressed?

Is the project completed? If no, what is the target date for completion? *

Please include qualitative and quantitative measures.

Has the project been terminated prior to completion or been changed in any way from its original objective? *

If yes, please explain why.

Was this project successful? *

Please explain.

Does your organization plan to continue this project? *

If no, please explain. If yes, what additional funding is needed and what are your anticipated funding sources?

Please send an attachment accounting how the grant funds were used to director@rchealthfoundation.org. *

Name *

This counts as your signature, ensuring all information in this report is correct to the best of your knowledge.

Position within Organization *

Date *

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