Small/Special Projects Impact Report - DUE ONE YEAR after funding begins.
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REVIEW PERIOD
The
REVIEW PERIOD
includes the full 12 month funding cycle, starting with the date funding was received.
AGENCY INFORMATION
Agency Name
First Name Contact Person
Last Name Contact Person:
Email Address Contact Person:
Phone Number Contact Person:
PROGRAM INFORMATION
Program Name:
Please select the area of impact of your program:
EDUCATION.
Children and youth are equipped to learn at every grade and are prepared for success after high school graduation.
HEALTH.
Individuals and families have access to healthcare, improve their health, or maintain their health.
FINANCIAL STABILITY.
Individuals and families improve their socio-economic status.
Summary of program. Describe the need this program addressed and the challenges and successes of implementation over the 12 month review period.
(250 words or less)
Describe your target population and how did this program served minorities and underserved populations:
(100 words or less)
PROGRAM BUDGET
When did the small/special project grant funding begin for this program?
Total amount of United Way Grant awarded for the 12 month review period:
$
Total amount of United Way Grant expended in the 12 month review period:
$
Percent of total award spent in the 12 month review period:
%
If you did not expend the entire amount of the grant monies received, please explain why (or write "entire amount spent":
(50 words or less)
Total Program Budget for the 12 month review period:
$
Program Expenditures for the 12 month review period:
$
Percent of total budget spent in the 12 month review period:
%
PROGRAM OUTCOMES/IMPACT
Measuring the success of your agency initiatives is an important part of effectively managing a program. UWGL must be able to show our donors that their contributions are truly making a positive difference in our community. Therefore, part of being a recipient of United Way funding is to offer evidence that what you did was effective.
Below we ask you to share what progress you made in the 12 month review period toward meeting your targeted program outcomes. The outcomes listed should match the outcomes you established in your application for funding. We require a
minimum
of one (1) outcomes and a
maximum
of four (4).
Program Outcomes/Impact in the Twelve (12) Month Review Period
Total Number of Clients (unduplicated) served in Allen County
Outcome Desired
Data/Tools Used to Track Progress
# of Clients Receiving Service
# Clients Achieving Desired Outcome
Target % Achieving Desired Outcome
% Achieving Desired Outcome
% of Clients Receiving Service
Outcome #1
Outcome #2
Outcome #3
Outcome #4
Comments on Outcome Results from the 12 month review period:
OPTIONAL (50 words or less)
DEMOGRAPHIC REPORTING
TIME FRAME FOR Demographic Reporting is the TWELVE MONTH period following the receipt of the United Way Small/Special Projects Grant.
Definition:
A
client served is a person who received services from your program.
In the case of a program which has membership, count only those who are officially members of the program.
Count
unduplicated
clients served at your
Allen County location
.
Count only the clients served
through the Program funded
by your United Way grant..
If your program/service is offered inside the schools, you may use the zip code of the school.
PLEASE NOTE:
The "totals" in each category should be the same from category to category.
Clients Served by Area of Residence
Please input the number of
unduplicated
clients served from each location listed below. Please count
only
clients served
in Allen County
through the funded program. If your program is offered inside the schools, use the zip code of the school where the service was provided.
Lima/Bath - 45801
Lima - 45802
Lima/Bath - 45804
Lima/Shawnee - 45805
Lima/Shawnee - 45806
Lima/Elida - 45807
Beaverdam - 45808
Gomer - 45809
Bluffton - 45817
Cairo - 45820
Delphos - 45833
Harrod - 45850
Lafayette - 45854
Spencerville - 45887
Unknown
Total Number of Clients Served by Residence
(this number should be the same for all categories
):
Clients Served by Age
Please input the number of
unduplicated
clients served from each age category listed below. Please count
only
clients
served in Allen County
through the
funded program
.
0 to 5 years
6 to 18 years
19 to 24 years
25 to 62 years
62 and above
Age Unknown
Total Number of Clients Served by Age Category
(this number should be the same for all categories)
:
Clients Served by Gender
Please input the number of
unduplicated
clients served from each gender category listed below. Please
count
only clients
served in Allen County
through the
funded program
.
Male
Female
Gender - Other
Gender Unknown:
Total Number of Clients Served by Gender Category
(this number should be the same for all categories)
:
Clients Served with Disabilities
Please input the number of
unduplicated
clients served from each disability category listed below. Please count
only
clients
served in Allen County
through the
funded program
.
Male with Disability
Female with Disability
Gender-Other with Disability
No Disability/Unknown
Total Number of Clients Served by Disability Category
(this number should be the same for all categories)
:
Clients Served by Race/Ethnicity
Please input the number of
unduplicated
clients served from each racial/ethnic category listed below. Please count
only
clients
served in Allen County
through the
funded program
.
African American
American Indian or Alaska Native
Asian
Caucasian
Hispanic or Latino
Multi-Racial
Pacific Islander
Ethnicity/Race Unknown/Other
Total Number of Clients Served by Racial/Ethnic Category
(this number should be the same for all categories)
:
Clients Served by Income Level
Please input the number of unduplicated clients served from each income level category listed below. Please count
only
clients
served in Allen County
through the
funded program
.
Above the Federal Poverty Level
Below the Federal Poverty Level
Income Level Unknown
Total Number of Clients Served by Income Level Category
(this number should be the same for all categories)
:
Additional Explanation
Feel free to record any additional explanations you feel would be helpful:
Optional (50 words or less)
AUTHORIZATION
I verify that I have reviewed the information provided and it is accurate and correct to the best of my knowledge.
Agency Executive Director/CEO - First and Last Name:
Agency Executive Director Email Address:
Date Completed:
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Small/Special Projects Impact Report - DUE ONE YEAR after funding begins.
Small/Special Projects Impact Report - DUE ONE YEAR after funding begins.