TGKVF Final Report Form

Today’s date:

Date Funds were received:

Project Start and End Dates:

Project Verification

Please ensure that the lead organization and the project title match the organization and the project title that were outlined in the original grant award letter.

Lead Organization:

Project Title:

Contact Information

Has your contact information changed? If so, please enter the new information below. If not, please leave blank.

First name of lead contact:

Contact Last Name:

Contact Phone number:

Contact E-mail:

Street Address:

City, State, Zip Code:

County where lead contact is based:

Demographic Information

  1. Which counties did this project serve? (May choose up to 5 – Boone, Clay, Fayette, Kanawha, Lincoln, Putnam or all 6 counties)
  1. How many people were served by this project?
  1. Which ethnicities primarily benefitted from your project?
  1. What age groups benefited from your project?

Project Description

  1. Give a one paragraph description of the project as implemented.

(Your language will be used for reports and other communications pieces. Limit responses to 4 sentences)

  1. How was the target population involved in the development, management, and/or evaluation of the project?

Impact Evaluation Information

It will be helpful to reference your original application to TGKVF as you complete this section.

  1. Which TGKVF priority area did your project impact? If different than the proposed priority area in your original application, please explain.

EducationHealthCivic EngagementArts & CultureBasic Needs

  1. What interventions did your project implement? If different than those described in your original application, please explain.

Arts & Culture and Basic Needs grantees should skip questions #3-4

  1. Which TGKVF objectives did your project impact? If different than the proposed objectives in your original application, please explain.
  1. Which TGKVF indicators of success and corresponding forms of wealth did your project impact?Are these still the indicators of success most relevant to your project? If not, please list the actual TGKVF indicators of success.
  1. Describe the specific impacts or anticipated changes as stated on your grant proposal. Beneath each anticipated impact or change, share the data or information collected that shows actual progress toward the desired change. It will be helpful to reference the impact/measurement chart that you submitted with the application.

Anticipated Change or Impact 1:

Data or information to show progress:

Anticipated Change or Impact 2:

Data or information to show progress:

Anticipated Change or Impact 3:

Data or information to show progress:

Anticipated Change or Impact 4:

Data or information to show progress:

  1. Overall, did your project produce the change or impact defined in your proposal? If yes, please name two or three of the main factors that helped the project succeed. If no, please name two or three of the main barriers that kept the project from producing the desired impact.
  1. Every project has a story to tell. Some are the stories that make it all worthwhile; others are the stories that keep us up at night. Please share a story of an individual or family who was impacted by the program this grant helped fund. (Please do not include any information that would identify a program participant or client.

Partner Information

  1. List and describe the roles played by each collaborating partner during this project.
  1. Will these partnerships continue? Why or why not?
  1. Please describe two or three major lessons learned about creating and/or managing the collaboration.
  1. Were any unexpected collaborative partnerships developed as a result of this project?

Financial Resources

  1. Did you successfully raise the necessary funds to fully implement the project? ____yes ____no

Please list the amounts raised and their sources:

$______Source: ______

$______Source: ______

$______Source: ______

$______Source: ______

If the full amount needed was not raised, how was the project’s implementation affected?

  1. What financial resources will be available for the continuation of this program/project? What is the plan for sustaining the program/project?
  1. Did this grant allow your organization to leverage in kind services? If so, how much and from what sources?
  1. Budget: Provide a project breakdown detailing the expenditure of TGKVF grant and other sources:

INCOME:TGKVF$______

Other sources$______

$______

$______

Total:$______

EXPENSES:

Project expenses (cash):$______

$______

$______

Total:$______

Please attach a detailed accounting ledger that explains how the funds were spent. If funds are remaining they must be returned to TGKVF. Receipts and invoices must be available upon request.

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