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GRANT REPORT
(Not to exceed 1 page) Grant Cycle 20__ - 20__ Fall/Spring
(circle one)
Agency:
Name of Person Preparing Report:
Mailing Address:
Telephone
No. + Ext.: _______________
E-Mail:
___________________________
Grant Project Title: Grant
Award: $
1. In the space
provided, provide an executive summary of your grant project.
2. From the following
list, please indicate the #served from each city by your grant project:
Alhambra__ Altadena__ Arcadia__ Duarte__ El Monte__ La Canada Flintridge__ Monrovia__ Monterey Park__
Pasadena__ Rosemead__ San Gabriel__ San Marino__ Sierra Madre__ South El Monte__ South Pasadena__
South San Gabriel__ Temple City__ Unincorporated
areas of LA Co. within the West San Gabriel Valley (please list w/#'s)______
TOTAL # SERVED _____
3. Age Groups:
# of Children/Youth
_____ # of Adults _____ # of Seniors __ TOTAL # SERVED _____
4. Gender Served:
# of Females _____ #
of Males _____ TOTAL # SERVED _____
5. Ethnic Breakdown:
# of
African-Americans _____ # of Caucasians _____ # of Latino/Hispanic/Chicano
_____
# of Asian-Americans
_____ # of Native Americans ___ Other (please describe) _________ TOTAL #
SERVED ___
6. In the space
provided, LIST the stated outcomes from your grant application and describe the
results from the funded project.
7. Please divide the
grant expenditures among the following 3 Expense Categories and provide copies
of receipts for any capital projects, including materials and supplies:
Personnel $
__________
Overhead/Administrative $ __________
Materials/Supplies $
__________
TOTAL $
__________
