Equity Innovation Fund Reporting Form | United Way of Racine County

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This report needs to be filled out at the end of the project you have received funding for. Please return to the Equity Innovation webpage if you are not at this stage.

Organization name

Executive director/CEO name

Name of person completing report

Email address of person completing report

Name of the project/program for which your organization received funding

How many people were served by your project/program?

Describe any deviance from proposed activities to actual activities.

What was innovative about your project/program?

What is the definition of success for a participant/client served by this project/program?

How did you measure success? Why did you choose this method? Was the measurement method appropriate?

Using your definition of success, describe the impact the funding had on your clients/participants and/or community.

What's next for the project/program?

Provide a 2-3 sentence statement of impact that can be used as a stand-alone quote. Include the name and title of the person quoted.

Financial Report Narrative: Describe any significant deviations from the original budget

Do you have unspent grant funds?

Yes

I understand that unused funds must be returned to United Way of Racine County

Amount of unspent funds to be returned to United Way of Racine County $

Is there any additional information you would like to report?

I will attach photos that demonstrate program impact to an email reply to the confirmation email upon submission of this report.

I will attach a financial report that documents grant fund expenditures to an email reply to the confirmation email upon submission of this report.

Note: After submitting your application, you will need to separately provide any photos (media releases included) that demonstrate the impact of your grant and/or show the grant work in action.

When you receive your automated confirmation email after submitting this application, please immediately attach any photos as a response.