2014 Wood Buffalo Big Spirit (WBBS) Grant Program Final Evaluation

Return this form, completed and signed, with supporting documentation within 45 days of the project end date or by December 15, 2014 (whichever comes first).

Evaluation checklist

To expedite processing, please ensure you have submitted:

☐ All invoices (invoices are required, statements and contracts cannot be accepted)

☐ All pages of the invoice (the entire invoice is required, not just the last page with the total amount)

☐ Itemized receipts for credit card/debit card payments (itemized receipts are required to show what was purchased)

☐ If invoice is in any currency other than CAD: currency conversion backup is required for invoice amounts (backup can include credit card statement, bank statement, etc. to show the amount paid in CAD)

☐ At least one sample from your each item associated with your marketing or collateral materials (print, web, brochure, etc.) to show the use of the ‘In partnership with Big Spirit’ logo (please send digital copy and not a scanned copy)

How to fill out Section 9: Actual Program/ Project Expenses

The evaluation form is user friendly. Please complete in the Word doc. (If extra lines are needed, simply right click and insert additional rows) and send the electronic document by email to . Hand-written submissions are often difficult to read and will delay the process.

Please organize all invoices by individual marketing tactic in the order listed on your project’s application form 9. Estimated Program / Project Expenses section and fill out 9. Actual program / Project Expenses section of the evaluation form accordingly: Program/Project Purpose of Expense

1.  Under the ‘Program/Project Purpose of Expense’ column, indicate which the expense was (ex. Printing, performer fees, etc.). Under “Company Name” indicate the name of the company on the invoice,

2.  Next, list each of your invoices individually for the indicated purpose of expense by listing the company, invoice number and invoice amount in CAD (excluding GST and HST)

3.  Complete this process for each invoice

4.  After all of your invoices have been entered, double check that all invoices are attached in the same order they are listed and check off the box that is marked “invoice and/or proof of payment included”

Note: If an expense was not included and approved on the application form, it cannot be included on the final evaluation unless you provided an interim report via e-mail include e-mail and corresponding approval to change the program/project.

1. Project Name:

(As it appears on your Funding Application)

2. Project Reference Number:

(As it appears on your Wood Buffalo Big Spirit Grant Program Letter of Approval)

3. Payment Recipient:

Name:
Company:
Address:
City:
Postal Code:
Phone No.:
Email:
4. Evaluation Submission Date:
MM / DD / YYYY

5. Were all Activities (as described in your Wood Buffalo Big Spirit Grant Application) Completed?

☐ Yes

☐ No (describe any variances from the project description)

6. Program/Project Objectives & Performance Measures:

List your goal(s), objective(s) and performance measure(s) as outlined in your application and include the results achieved.

Goals
(as described in application) / Objectives / Targets
(as described in application) / Performance Measures
(as described in application) / Results

7. Did This Project:

☐ Exceed your program/project goals and objectives

☐ Meet your program/project goals and objectives

☐ Fail to meet your program/project goals and objectives

8. Comments and Recommendations:

Include factors that contributed to the overall results of the program/project – either positive or negative. Would you recommend implementing these activities in future programs/projects? Indicate why or what changes/improvements could be made. Include any unexpected results, positive or negative.

9. Actual program / Project Expenses:

To expedite processing, please submit your receipts/invoices in the order they are listed below.

Program/Project Purpose of Expense (name the expense as a line item) / Supplier / Company / Invoice
Number / Invoice Amount
(Excluding GST/HST) / Invoice and/or Proof of Payment Included
(Committee use)
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
Total Cost / $

10. Program / Project Revenues:

Revenue Stream Name (source of funds, revenues, income, etc.) / Company/Organization Location (city, province) / Revenue ($) / Eligible Amount
(Committee use only)
Total / $

Evaluation Sign-Off:

I ______(Project Manager), hereby verify that the information submitted in this evaluation is accurate and can be verified with original documentation if required. I understand the eligibility criteria and program audit requirements.

Name:

Signature:
Date:
MM / DD / YYYY

I ______(2nd Project Manager), hereby verify that the information submitted in this evaluation is accurate and can be verified with original documentation if required. I understand the eligibility criteria and program audit requirements.

Name:

Signature:
Date:
MM / DD / YYYY

I ______(Sponsor/sponsoring organization representative), hereby verify that the information submitted in this evaluation is accurate and can be verified with original documentation if required. I understand the eligibility criteria and program audit requirements.

Name:

Signature:
Date:
MM / DD / YYYY

Evaluation Submission:

Please submit your project evaluation to the Wood Buffalo Big Spirit Grants Program Committee no later than 45 days (or by December 15, 2014) after project completion by e-mail:

Version: April 10, 2014

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