Report Date: This Is a Progress Report This Is a Final Report (Check One)

GRANT REPORT

Report Date: This is a progress report This is a final report (check one)

I. ORGANIZATION

Organization Name
Legal Name (if different)
Address
City / State / Zip Code
Phone Number / Fax Number
Website
Chief Board Officer & Title
Chief Staff Officer & Title
Total Organizational Budget / $ / for fiscal year from:
(month & year) / to:
(month & year)
Have there been any
changes to your organization's IRS 501(c)3
nonprofit status since
your request for this grant? / No Yes (please explain)

II. PROJECT

Project Name
Two Sentence Description
of Project
Grant Amount & Period / $ / from:
(month & year) / to:
(month & year)
Dates Covered by this Report / from:
(month & year) / to:
(month & year)

III. PROJECT CONTACT

Project Contact & Title
Address
City / State / Zip Code
Phone Number / Fax Number
E-mail Address

IV. PROJECT DESCRIPTION

Describe the project or program for which your organization received funding from the Dyson Foundation and how it related to the mission of your organization.

V. IMPLEMENTATION

Describe the organization’s experience executing the project or program including the implementation strategy and timeline and any issues your organization faced when implementing this project. How did you resolve major issues? What modifications to the original project or program plan were made and why?

VI. PROJECT GOALS

What were the project’s original goals? What modifications were made to those goals and why?

VII. EVALUATION AND OUTCOMES

A. Describe the population served. Include numbers served, age, gender, ethnicity, and socio-economic status. Give exact numbers rather than percentages. How was the population affected by the project? How were other stakeholders affected?

VII. EVALUATION AND OUTCOMES (continued)

B. How did your organization measure the effectiveness of your project? What did the organization learn? How has the organization used this information or how will it use this information? What were the unexpected results, positive and negative? If this funding was for a multi-year project, what changes in the project will be implemented in the upcoming year as a result of your evaluation of this year’s activities?

VII. EVALUATION AND OUTCOMES (continued)

C. Were there any changes in the original staffing pattern for the project or any significant changes in the organization while implementing this project?

VIII. SUSTAINABILITY

Please restate the organization’s long-term plans for funding this project that were presented in the original proposal to the Dyson Foundation and the progress the organization has made towards this end. What modifications have been made to these plans and why?

IX. GRANT SUMMARY

If this is a report on the final year of a multi-year grant, please give a summary of the project over the entire multi-year grant term. Are you planning to continue the project? Is there anything else you would like to add?

X. ATTACHMENTS

Please include the following documents with your application.
Project Budget Reporting Form(located on our website) – Provide project income andexpenditures to-date compared to the approved budget. If there are any discrepancies, please explain.
Other Materials – Include the following items, if available and not previously submitted to the Dyson Foundation.
The most recent audited financial statement.
The most recent annual report.
No more than three of the most recent publications, news articles, or other relevant materials
about the organization or the funded project. Please be selective.

Page 1 – Grant Report