Grantee Name:
Grant Tracking#:

F. R. Bigelow Foundation

Grantee Evaluation Results

To Complete this form: Please refer to your Grantee Evaluation Plan for the above named grant to complete the Activities, Outputs, and Outcomes sections of this Grantee Evaluation Result form. The Grantee Evaluation Plan referenced was completed and submitted by your organization when the grant was approved. Activities, Outputs, and Outcomes cannot be changed from the original Grantee Evaluation Plan.

ACTIVITIES: List activities as written in the original Grantee Evaluation Plan and indicate the degree to which each activity was achieved. If any of the proposed activities were not fully achieved, explain why in the Narrative Report. (Activities were defined by the organization & approved by the Foundation’s assigned Program Officer at the time the grant was approved)

1.
Fully Achieved / Partially Achieved / Not Achieved
2.
Fully Achieved / Partially Achieved / Not Achieved
3.
Fully Achieved / Partially Achieved / Not Achieved

OUTPUTS: List output(s), proposed output(s), and Data Collection method(s) as defined in your original Grantee Evaluation Plan. Indicate your actual outputs for this grant, as measured by the data collection method(s). If the proposed outputs were not fully met, explain why in the Narrative Report. (Your organization chose Outputs from a defined list specified by the Foundation at the time the grant was approved)

Description of each
Proposed Output(s)Proposed
Selected from a defined list / # for each Proposed
Outputs / # for each
Actual
Outputs / Data Collection Method for each Output

OUTCOMES: List Outcome(s) and Data Collection Method as defined in your original Grantee Evaluation Plan. Indicate your progress toward achieving the outcomes for the grant as measured by the data collection method(s). If any the proposed outcomes were not fully achieved, explain why in the Narrative Report. (Outcomes and data collection methods were determined by the organization and approved by the Foundation’s assigned Program Officer at the time the grant was approved.)

Proposed Outcome(s) / Actual Outcomes
Achieved (circle) / Data Collection Method for each Outcome
Fully Achieved
Partially Achieved
Not Achieved
Fully Achieved
Partially Achieved
Not Achieved

1