Legal Name of Organization*
DBA (if applicable)
Street 1*
Street 2
City*
State*
Zip*
Phone* (do not include dashes)
Fax
Employer Identification Number (EIN)* (do not include the dash)
Website
Organization Email*
CEO/Executive Director
Phone (do not include dashes)
Email
Report Contact & Title (if not the CEO/Executive Director)
Grant Amount* (do not include commas)
Event Name*
Event Date*
How many people attended the event?* (do not include commas)
What were the successes and challenges of the event?*
If the event was a fundraiser, what was the net income raised? (do not include commas)
Were actual event costs consistent with original estimates?* (do not include commas) ---YesNo Please explain:*
What was the event gross revenue?* (do not include commas)
What were the event expenses?* (do not include commas)
Any additional Information you would like to include?
By checking here, I certify that the information contained in this report is true and correct to the best of my knowledge.
* Denotes required field