Date of Final Report

APPLICANT DETAILS

Recipient Name: Title (if representing an organization:

Organization or Affiliation (if Applicable):

Award Amount $

Date of Need or Opportunity:

Start date End Date:

Contact Phone:

Cell Phone

Email Address:

This Application wa for (pick one) Student Non-Profit Organization Individual School Other

If Other --- Describe:

Grant Details

Type of Need: Unexpected Opportunity or Event Unforseen Need

Type 1 - Unexpected Opportunity or Event (i.e, a rare, unexpected and unplanned opportunity or event arises.) OR,

Type 2 - Unforseen Need (i.e., Something happens which is not within the control of the individual or organization and causes unforeseen consequences.)

How did you hear about this grant opportunity?

Summary of how you or your organization used the funds :

Did funding help you meet your goals? Yes No

Please describe:

Were you able to gain additional financial assistance or other assistance as a result of this award? Yes No

Please Explain:

Do you have any additional comments you would like to share with the Coalition?

I certify that all statements made in this final report are true to the best of my knowledge and in accordance with the reporting criteria for this program.

By typing your name you certify and confirm all information and statements above:

You may submit up to 2 supporting images or documents to show how funds were used by emailng to info@clackamasculturalcoalition.org. If you have any questions, please call 503-655-0525. You should receive email confirmationwithin 48 hours that your report was received. If you do not receive an email confirmation please call us.