Herbert Simon Family Foundation grant report

Please try to be clear and concise in your answers by using bullet points for each response.

This form can not be saved or submitted until it is complete. It is recommended that you prepare all of your answers to this report prior to completing this online form.

Questions?

Contact Clayton De Fur at 317.634.2423 or HerbertSimonFamilyFoundation@cicf.org.

Organization Information

Name of Organization *

Organization's Mission Statement *

Upload Organization's Preferred Logo

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Maximum file size: 268.44MB

Please upload a high-resolution print quality version of your logo.

Contact Person's First Name *

Contact Person's Last Name *

Contact Person's Title or Role with Organization *

Email *

Phone Number *

Grant Information

Grant Number *

Grant/Project Title *

Grant/Project Purpose *

Type of Report *

Progress

Final

Impact Area *

Healthy Living

Basic Needs

Arts and Culture

Environment

Education

Award amount *

Date Awarded *

Upload 2 or 3 photos that represent the grant's impact on your organization.

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Maximum file size: 268.44MB

Photos need to be high-resolution and print quality images.

Output Data

If applicable, how many people were served by this grant? (Unduplicated #)

Note: if people were not directly served by this grant, please leave this question blank.

What percentage of served is female?

What percentage of served is male?

What percentage of served is youth (0-17)?

What percentage of served is adult (18-65)?

What percentage of served is seniors (65+)?

What percentage of served is low-income? (qualifies for reduced/free lunch)

Describe the progress made toward your proposed goals and outcomes related to this specific grant. Please enter both proposed and actual outcomes.

First proposed outcome: *

First actual outcome: *

Second proposed outcome:

Second actual outcome:

Third proposed outcome:

Third actual outcome:

Describe any unexpected benefits or challenges that occurred during the term of the grant and discuss any significant lessons learned. Please include how you will use any lessons learned or results to improve your organization or program: *

Recognition

How was this grant recognized? *

Please include visual(s) of grant recognition.

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Maximum file size: 268.44MB

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Financial Accounting for the Grant

In each expense category below, provide a brief description of the actual project expense. Not all expense categories apply to all grants.

Expense Categories:

Employee Compensation, Benefits and Taxes

Description of Expenses (Employee Compensation, Benefits and Taxes)

Actual Expense (Employee Compensation, Benefits and Taxes)

Amount of Herbert Simon Family Foundation grant used (Employee Compensation, Benefits and Taxes)

Professional Fees & Contracted Labor

Description of Expenses (Professional Fees & Contracted Labor)

Actual Expense (Professional Fees & Contracted Labor)

Amount of Herbert Simon Family Foundation grant used (Professional Fees & Contracted Labor)

Professional Development

Description of Expenses (Professional Development)

Actual Expense (Professional Development)

Amount of Herbert Simon Family Foundation grant used (Professional Development)

Printing & Publications

Description of Expenses (Printing & Publications)

Actual Expense (Printing & Publications)

Amount of Herbert Simon Family Foundation grant used (Printing & Publications)

Supplies

Description of Expenses (Supplies)

Actual Expense (Supplies)

Amount of Herbert Simon Family Foundation grant used (Supplies)

Marketing & Advertising

Description of Expenses (Marketing & Advertising)

Actual Expense (Marketing & Advertising)

Amount of Herbert Simon Family Foundation grant used (Marketing & Advertising)

Travel & Transportation

Description of Expenses (Travel & Transportation)

Actual Expense (Travel & Transportation)

Amount of Herbert Simon Family Foundation grant used (Travel & Transportation)

Equipment

Description of Expenses (Equipment)

Actual Expense (Equipment)

Amount of Herbert Simon Family Foundation grant used (Equipment)

Other (specify)

Description of Expenses (Other)

Actual Expense (Other)

Amount of Herbert Simon Family Foundation grant used (Other)

If you are human, leave this field blank.