Training and Technology Fund Reporting Form

Organization name

Executive director or CEO's name

Name of person completing report

Email of person completing report

Are you reporting on a training fund or technology fund grant?

Training

Technology

Training

Name of the training for which your organization received funding

Describe any deviance from proposed activities to actual activities

Actual amount of United Way training funds expended

Was your training fund award based on reimbursement?

Yes

Amount requested for reimbursement

Note: After submitting your application, you will need to separately provide paid invoices/receipts that support the amount requested for reimbursement.

When you receive your automated confirmation email after submitting this report, please immediately attach your invoices/receipts as a response.

I understand.

Organization name as it should appear on the reimbursement check

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Describe the direct impact the funding had on your organization, staff and/or board. How did this funding increase skills/knowledge, improve efficiency/capacity, support the advancement of your mission, and/or deepen your efficacy/impact?

Describe the indirect impact the funding had on your clients/participants and/or community.

Note: After submitting your application, you will need to separately provide any photos (media release included) that demonstrate the impact of your grant and/or show the training in action (e.g., photo of participants at conference, a staff member holding a certificate of completion, etc.).

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

I understand.

For each individual who received training, provide a 2-3 sentence personal reflection that connects the learning objectives proposed in the grant application to what they learned and how they’re using the knowledge/skills in their work.

Provide a 2-3 sentence statement of impact that can be used as a stand-alone quote.

Name of person quoted

Title of person quoted

Number of staff members who received training

Number of board members who received training

Total number of training hours completed

Demographics of individuals who received training (will be used in aggregate form only)

Technology

Name of the technology for which your organization received funding

Describe any deviance from proposed activities to actual activities

Actual amount of United Way technology funds expended

Was your technology fund award based on reimbursement?

Yes

Amount requested for reimbursement

Note: After submitting your application, you will need to separately provide paid invoices/receipts that support the amount requested for reimbursement.

When you receive your automated confirmation email after submitting this application, please immediately attach your invoices/receipts as a response.

I understand.

Organization name as it should appear on the reimbursement check

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Describe the indirect impact the funding had on your clients/participants and/or community.

Note: After submitting your application, you will need to separately provide any photos (media release included) that demonstrate the impact of your grant.

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

I understand.

Proved a 2-3 sentence statement of impact that can be used as a stand-alone quote.

Name of person quoted

Title of person quoted

Number of staff members directly impacted by this technology

Number of board members directly impacted by this technology

Is there any additional information you would like to report?

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Training and Technology Fund Reporting Form

Training

Technology

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