Final Report: Short Form

Pacific Salmon Foundation Community Salmon Program

FINAL REPORT: SHORT FORM

Pacific Salmon Foundation

Community Salmon Program (CSP)

Final Report, SHORT FORM

Introduction and Instructions (Do not include with application)

To be used to report on Short Form grants only, please check your application type before using

Please submit your Final Report within 60 days after completion of your project.

Maximum one year from Date of Grant (Date of letter included with your cheque)

The Pacific Salmon Foundation thanks you for undertaking work to benefit salmonids in the wild. Your efforts, combined with the works of others, are making a difference.

You are appreciated.

·  This form has been developed to help you report your accomplishments to PSF

·  Please use this form for your Final Report, do not send final report in other formats; however, in addition to completing this form you may also attach an alternate report

·  The information you provide will be used to document the specific and overall accomplishments of your project and the effectiveness of the Community Salmon Program in working toward its intended outcomes

·  Your Final Report and statement of expenditure are due 60 days after the completion of your project, maximum 12-month after of the Date of Grant (One year and two months after you receive your cheque)

·  Attach original receipts for all PSF funded expenditures, if you need them to be returned please indicate

·  Residual grant funds are to be returned with Final Report

·  Photocopy your receipts and report and retain copy for your records

·  Forward one signed copy of Final Report, original receipts, project photos and maps to:

Pacific Salmon Foundation

Community Salmon Program

#300 – 1682 West 7th Avenue

Vancouver, BC

V6J 4S6

www.psf.ca

Please also email a copy to

Please keep a complete copy for your records

Need Help? Please Contact:

Jim Shinkewski

Salmon Programs Coordinator

604 664-7664 ex 112

Insert Project Photo

Project Number / CSP -
Organization
Project Title
Project Type
Grant Amount / $
Total Project Value / $
Stream and Receiving Waters Name
Nearest Town/City
Target Salmonid Species
Primary Contact Person
Address
City/Province/Postal Code
Phone /Email / T: E:

Reminder List: Final Reports Original Receipts Project Photos Hard-Copy Residual $ .

E-copy

Section A PURCHASE INFORMATION

What did you purchase?

Did this purchase benefit your program or project as you anticipated? Please provide details, as appropriate:

Section B STATEMENT OF EXPENDITURES

Please provide a statement of PSF grant expenditures, project leveraging, in-kind and other funds

Attach original receipts for only PSF expenditures to this Final Report

EXPENSE TYPE – Please circle :
Materials, Supplies, Equipment, Professional Fees, Training / PSF CSP
($) / OTHER CASH ($) / IN-KIND
($)
EXPENSE, SUPPLIER
A TOTAL PSF CSP EXPENDITURES / $
B TOTAL OTHER / $
C TOTAL IN-KIND / $
D TOTAL PROJECT VALUE A+B+C / $
E PSF CSP GRANT / $
LESS TOTAL PSF CSP EXPENDITURES A / $
OUTSTANDING GRANT TO BE RETURNED TO PSF / $

I hereby declare that the information contained in the above financial statement submitted by us to PSF is accurate in all material respects. Any Tax Credit received or receivable by us has been declared in the budget portion of the Final Report; and that the funds were used exclusively for the project as originally proposed or as formally amended by PSF.

------

Signature Name (Please Print) Title Date

Page 1 of 3