{"id":4730,"date":"2025-01-15T16:47:27","date_gmt":"2025-01-15T16:47:27","guid":{"rendered":"https:\/\/ccccf.us\/wordpress\/?page_id=4730"},"modified":"2025-01-15T16:47:27","modified_gmt":"2025-01-15T16:47:27","slug":"grant-report-form","status":"publish","type":"page","link":"https:\/\/ccccf.us\/wordpress\/grant-report-form\/","title":{"rendered":"Grant Report Form"},"content":{"rendered":"\n<div class=\"wp-block-uagb-container uagb-block-5b05212e alignfull uagb-is-root-container\"><div class=\"uagb-container-inner-blocks-wrap\">\n<div class=\"wp-block-uagb-container uagb-block-6d89a5ed\">\n<div class=\"wp-block-uagb-info-box uagb-block-d8d21ca9 uagb-infobox__content-wrap  uagb-infobox-icon-above-title uagb-infobox-image-valign-top\"><div class=\"uagb-ifb-content\"><div class=\"uagb-ifb-title-wrap\"><h2 class=\"uagb-ifb-title\">Grant Report Form\u200b<\/h2><\/div><div class=\"uagb-ifb-separator\"><\/div><\/div><\/div>\n<\/div>\n\n\n<div class=\"wpforms-container wpforms-block wpforms-block-99249301-03f4-417e-8df2-7ff21d0c8d8c\" id=\"wpforms-4683\"><form id=\"wpforms-form-4683\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"4683\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/wordpress\/wp-json\/wp\/v2\/pages\/4730?wpforms_form_id=4683\" data-token=\"da27e04acab40259eb9058afad44f3f5\" data-token-time=\"1776348581\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-4683-field_30-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"30\"><label class=\"wpforms-field-label\">Check One<\/label><ul id=\"wpforms-4683-field_30\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4683-field_30_1\" name=\"wpforms[fields][30][]\" value=\"6-Months (Interim) Report, (Submit this cover sheet, questions 1 and 2, and the attachments)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4683-field_30_1\">6-Months (Interim) Report, (Submit this cover sheet, questions 1 and 2, and the attachments)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4683-field_30_2\" name=\"wpforms[fields][30][]\" value=\"Year 1 Final Report, (Submit this cover sheet, questions 1 \u2013 8 and the attachments)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4683-field_30_2\">Year 1 Final Report, (Submit this cover sheet, questions 1 \u2013 8 and the attachments)<\/label><\/li><\/ul><\/div><div id=\"wpforms-4683-field_31-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_31\">Grant Name<\/label><input type=\"text\" id=\"wpforms-4683-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\" ><\/div><div id=\"wpforms-4683-field_13-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_13\">Date<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4683-field_13\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][13][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-4683-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_11\">Name of Organization<\/label><input type=\"text\" id=\"wpforms-4683-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" ><\/div><div id=\"wpforms-4683-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_10\">Grant Administrator<\/label><input type=\"text\" id=\"wpforms-4683-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-4683-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_12\">EIN#<\/label><input type=\"text\" id=\"wpforms-4683-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" ><\/div><div id=\"wpforms-4683-field_3-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"3\"><label class=\"wpforms-field-label\">Address<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-4683-field_3\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][3][address1]\" ><label for=\"wpforms-4683-field_3\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-4683-field_3-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][3][address2]\" ><label for=\"wpforms-4683-field_3-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-4683-field_3-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][3][city]\" ><label for=\"wpforms-4683-field_3-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-4683-field_3-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][3][state]\" ><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select state &#8212;<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-4683-field_3-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-4683-field_3-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][3][postal]\" ><label for=\"wpforms-4683-field_3-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-4683-field_32-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_32\">Phone<\/label><input type=\"tel\" id=\"wpforms-4683-field_32\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][32]\" aria-label=\"Phone\" ><\/div><div id=\"wpforms-4683-field_33-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_33\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-4683-field_33\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][33]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-4683-field_4-container\" class=\"wpforms-field wpforms-field-url\" data-field-type=\"url\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_4\">Contact Person<\/label><input type=\"url\" id=\"wpforms-4683-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" ><\/div><div id=\"wpforms-4683-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_34\">Title<\/label><input type=\"text\" id=\"wpforms-4683-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" ><\/div><div id=\"wpforms-4683-field_35-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_35\">Grant Amount<\/label><input type=\"text\" id=\"wpforms-4683-field_35\" class=\"wpforms-field-medium\" name=\"wpforms[fields][35]\" ><\/div><div id=\"wpforms-4683-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_36\">Cycle Number<\/label><input type=\"text\" id=\"wpforms-4683-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\" ><\/div><div id=\"wpforms-4683-field_37-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"37\"><label class=\"wpforms-field-label\">Type<\/label><ul id=\"wpforms-4683-field_37\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-4683-field_37_1\" name=\"wpforms[fields][37]\" value=\"New Project\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4683-field_37_1\">New Project<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-4683-field_37_2\" name=\"wpforms[fields][37]\" value=\"New Program\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4683-field_37_2\">New Program<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-4683-field_37_3\" name=\"wpforms[fields][37]\" value=\"New Initiative\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4683-field_37_3\">New Initiative<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-4683-field_37_4\" name=\"wpforms[fields][37]\" value=\"New Research\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4683-field_37_4\">New Research<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-4683-field_37_5\" name=\"wpforms[fields][37]\" value=\"Extended Program\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4683-field_37_5\">Extended Program<\/label><\/li><\/ul><\/div><div id=\"wpforms-4683-field_38-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_38\">Reporting Period Start Date<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4683-field_38\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][38][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-4683-field_39-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_39\">Reporting Period End Date<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4683-field_39\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][39][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-4683-field_42-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"42\"><div id=\"wpforms-4683-field_42\" class=\"wpforms-field-medium wpforms-field-row\"><p><span style=\"text-decoration: underline\"><strong>Complete the section above, questions 1 and 2, for your 6-month (Interim) report. Complete all the questions ONLY if this is the 1ST year report. Your 2nd year (Final) report, do not require questions 1 \u2013 2, only the section above and questions 3 \u2013 8. Include the additional attachments at the bottom with every report (unless indicated) and nothing extra.<\/strong><\/span><\/p>\n<p><strong>Provide an <span style=\"text-decoration: underline\">expense report<\/span> indicating how the grant award was used. If this is a <span style=\"text-decoration: underline\">6-month (Interim) report<\/span>, please <span style=\"text-decoration: underline\">indicate expenses to date<\/span>.<\/strong><\/p>\n<p><strong>Respond to each of the following questions in the exact order using up to 3 (three) pages in total if needed (not including the cover page above). Your responses should focus specifically on the funded project; program or initiative and how it affected your clients or target group and benefitted the community. <\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-4683-field_43-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_43\">1. List up to five accomplishments or your progression towards meeting your goals and objectives so far.<\/label><textarea id=\"wpforms-4683-field_43\" class=\"wpforms-field-medium\" name=\"wpforms[fields][43]\" ><\/textarea><\/div>\t\t<div id=\"wpforms-4683-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-4683-field_1\" >or List impacted<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-4683-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-4683-field_44-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_44\">2. Describe any setbacks encountered during this period of your grant funding. How did these setbacks impact your organization or project? How were these setbacks addressed?<\/label><textarea id=\"wpforms-4683-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" ><\/textarea><\/div><div id=\"wpforms-4683-field_45-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_45\">3. Referring to the goals and objectives described in your original grant request (or any revisions submitted subsequent to the grant award), please indicate the following: How many (or how many more) clients were you able to serve as a result of this grant funding? What measures were used to determine your progress?<\/label><textarea id=\"wpforms-4683-field_45\" class=\"wpforms-field-medium\" name=\"wpforms[fields][45]\" ><\/textarea><\/div><div id=\"wpforms-4683-field_46-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_46\">4. What were the unexpected results or key learning\u2019s you would share with funders?<\/label><textarea id=\"wpforms-4683-field_46\" class=\"wpforms-field-medium\" name=\"wpforms[fields][46]\" ><\/textarea><\/div><div id=\"wpforms-4683-field_47-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_47\">5. Who else has funded or supported this project (or your organization), and at what level? If total proposed budget amount was not raised or supported, indicate if program goals were altered in any way.<\/label><textarea id=\"wpforms-4683-field_47\" class=\"wpforms-field-medium\" name=\"wpforms[fields][47]\" ><\/textarea><\/div><div id=\"wpforms-4683-field_48-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_48\">6. What steps are being made to ensure the sustainability of your project or organization beyond this grant period?<\/label><textarea id=\"wpforms-4683-field_48\" class=\"wpforms-field-medium\" name=\"wpforms[fields][48]\" ><\/textarea><\/div><div id=\"wpforms-4683-field_49-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_49\">7. If your program involved collaboration with other organizations, please comment on their effect upon the program.<\/label><textarea id=\"wpforms-4683-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" ><\/textarea><\/div><div id=\"wpforms-4683-field_50-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_50\">8. Explain how your project\/program impacted the health or resolved a medically related issue for the Citrus County community.<\/label><textarea id=\"wpforms-4683-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" ><\/textarea><\/div><div id=\"wpforms-4683-field_51-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"51\"><div id=\"wpforms-4683-field_51\" class=\"wpforms-field-medium wpforms-field-row\"><p><strong>Scan and email 1 (one) of each of these as additional attachments for all the reports including the 2nd Year (Final) Report (unless indicated):<\/strong><\/p>\n<ul>\n<li><strong>Promotional\/dissemination\/informational material (i.e. brochure, flyer, ad (with the CCCCF, Inc. logo) or news clippings. Not required for the 2nd-Year Report)<\/strong><\/li>\n<li><strong>The two required press releases (attach to the 1st Year Report only)<\/strong><\/li>\n<li><strong>List of current Board of Directors<\/strong><\/li>\n<li><strong>Most recent audit, account review, or end of year financial statement (email only one) and a copy of either your filed 990, 990N, or 990EZ showing expenditures associated with this grant. (All paid invoices and receipts for this grant must be held for three (3) years in case of an audit)<\/strong><\/li>\n<li><strong>Proof of compliance with Section 5, a \u2013 i, from your signed CCCCF, Inc. Grant Agreement<\/strong><\/li>\n<\/ul>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-4683-field_52-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-4683-field_52\">File Upload<\/label><div\n\t\tclass=\"wpforms-uploader 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