GRANTS PROGRAM EVALUATION REPORT FORM

FY14Grants

FORM IS DUE NO LATER THAN August 1, 2014

Utah Division of Arts & Museums Grants ProgramOFFICE USE ONLY

617 East South TempleDate received

Salt Lake City, Utah 84102-1177

(801) 236-7550

FOR GRANTEE’S COMPLETION

/ Please type this report and make a copy for your records before mailing. Please be as concise as possible.
Grantee Organization
Mailing Address
CityUtahZIP Code
Contact PersonPhone
Email Address
Grant Opportunity
Project Title:
(not applicable for operations grants)

DESCRIPTION

/ Describe in the space below how the grant monies were used, with a concise assessment of its impact and successes.
How did your project differ from what you proposed in your application?
Participating artists and/or organizations (please specify names)

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Actual number of individuals benefiting from the project:
The total number of individuals who were directly involved in the funded activity as artists, non-artist project participants or audience members between the project start and end dates. This number should include only those individuals directly affected by or involved in the funded activity, and should include the totals from Artists Participating and Youth Benefiting (below). Include actual audience numbers based on paid/free admissions or seats filled. Avoid inflated numbers, and do not double-count repeat attendees.
Actual number of artists participating:
Artists directly involved in providing art or artistic services specifically identified with the project. This figure to be included in number of Individuals Benefiting above.
Actual number of children and youth benefiting from the project:
This figure to be included in number of Individuals Benefiting above.

PROJECT BUDGET

/ Grant Amount Requested
Grant Amount Approved
Actual Total Cash Expenses (The actual total of all cash payments made by the organization specifically identified within the grant.)
Actual Total Cash Income (The actual total of all cash income specifically identified within the grant, including "Grant Amount Spent".)
Actual Total In-Kind Contributions (The actual total value of expenses specifically identified within the grant that is provided to the organization by volunteers or outside parties at no cash cost to the organization.)

EVALUATION

/ Please give your honest evaluation of the project.
(Things to consider: Should it reach more people? If it is a continuing project, is it still valuable? Does the project merit funding with state dollars? What are the project’s strengths/weaknesses? Does the organization/program have a quality track record? Is the administrative management sound? etc.)

CERTIFICATION

/ I/We certify that the foregoing information is true and correct and that all expenditures were incurred solely for the purpose of the above-mentioned grant.
REPORTED BY
NameSignature
Title
DateTelephone
When completed, please mail this form to: Grants Officer
Utah Division of Arts & Museums
617 East South Temple
Salt Lake City, Utah 84102-1177

NOTE

/ If applicable, the final 20% payment on your grant award will be mailed to you on receipt of this form at the Utah Division of Arts & Museums office.
The 20% payment should be mailed to:
Name
Address
CityUtahZIP Code

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