(Revised September 2014)

GRANT EVALUATION FORM

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GRANT YEAR *

TYPE OF GRANT BEING RECEIVED: *

Benevolence Fund Grant

Hunger Fund Grant

(If you received one of each type, a separate evaluation form is needed for each.)

Deadlines

Mid-term – June 1 for Fall Cycle Grant; October 15 for Spring Cycle Grants

(Actual expenditure accounting statement is not needed for mid-term report)

Final Evaluations – October 15 for Fall Cycle Grants; April 1 for Spring Cycle Grants

(A statement of actual expenditures with receipts is needed for final report –

and all funds must have been expended.)

A. Date evaluation submitted: * 🛈 +

B. Name of program: * 🛈

Postal mailing address: *

City *

State *

Zip Code *

C. Your name * 🛈

D.Your title or relationship to project: *

E. Your Contact Information: Mailing address *

City *

State *

Zip Code *

Phone Number *

Email Address *

F. The Church Federation has organized the city into Quadrants Plus One based on Washington St. east and west, Meridian St. north and south, and a distinctive Downtown area, with each being in conversation with congregations, service agencies, and the wider community to both share information on local efforts and to develop collaborative efforts. This program is still being built with some areas more active than others. Has anyone from your quadrant/area of the city been in contact with you to include your project in these conversations? *

Yes

No

1. SUMMARY – (Refer to the Summary section on your original application.) What specific activities were/are being underwritten with this grant? What was/is your anticipated timeline for expending these funds? Are you on target? How many volunteers are involved? How many paid leadership/staff? How many participants are involved? How do you make this total involvement visible to your congregation and to the community? *

2. LEADERSHIP – (Refer to the Leadership section on your original application.) Have you had any changes or additions in leadership? *

Yes

No

If yes, provide new leadership name(s) and contact information: *

3. PARTNERS – (Refer to the Partners section on your original application.) Have you added partners (e.g. churches, key individuals, businesses, schools, etc.) since your original application? *

Yes

No

If yes, provide new partner name(s) and contact information: *

4. DOCUMENTATION – Have you been able to document your project’s best practices to date in order to include with your final report? *

Yes - Attach only with final report

No

If no, what are your plans to do so? *

5. IMPACT – How do you define your service area? What difference has this project made with your project participants? With your own congregation? In your community? *

If you are a Food Pantry: How many clients have you served during the period covered by this report? If possible break down as follows (this data is the same as required by Gleaners Food Bank):

Total number of families served: *

What % are "regulars" returning at least monthly? *

Ages served:

	-
0 - 5	-
6 - 17	-
18 - 64	-
65+	-

What is your standard procedure for handling those not eligible for food from your program? *

6. CHALLENGES – What have been your key challenges in accomplishing your project goals? Have any new challenges surfaced that have inhibited your success? *

7. EVALUATION – Share one success story or one unexpected joy. How have your success stories been shared with your own congregation? With your community? *

8. FUTURE – How has your dream of your program’s future been changed as a result of your activities? *

9. BUDGET - A statement of your actual expenditures reflecting this grant, along with supporting documentation, is due with the final report only.

Please attach budget and any additional information that supports your evaluation (examples: photos, testimonials etc.)

Questions or concerns? Contact grants@churchfederationindy.org.