NWRDC/McKnight Small Capital
| FOR OFFICE USE ONLY | ||
| Grant # _______________ | Due Date _______________ | Date Rcvd _______________ |
| Award _______________ | Credit Line _______________ | Approved _______________ |
| Comments: |
This form is due within 60 days of issue of funds. Call our office immediately to request an extension if your equipment is back ordered.
| 1.
Grant Recipient (Legal
Name, Address, Phone) Phone |
2.
Project Director (Name,
Address, Day Phone) Phone |
3. Briefly describe the project,
including a list of your project goals as described in the application. Indicate
how well the goals were met.
4. How did you make the public aware that you received
this grant? Attach evidence of use of the credit line in the Arts Grant Contract
along with any newspaper clippings, programs, etc.
5. Did the project differ from the description in the
grant application in any way? If so, describe.
6. If funds were used for capital expenses, attach evidence of purchase and list:
| Description | Model Number/s | Serial Number/s | Accessories | |||
7. Budget Summary
| Estimated Budget (from application) | Actual Budget | ||
| Expenses | Capital Costs (Equipment) | ||
| Supplies and Materials (Expendable Items) | |||
| Other Costs | |||
| TOTAL EXPENSES | |||
| Income | NWRDC Grant | ||
| Cash | |||
| Other Grants | |||
| TOTAL INCOME |
* NOTE: If actual expenses for capital costs are less than budgeted, the balance must be returned.
8. Suggestions for improved Northwest
Regional Arts Council Services.
9. CERTIFICATION: We certify that the information contained in this report is true and that all costs reported were accrued in accordance with the conditions of this grant. (Two people must sign)
| Typed Name | Title | Signature | Date | |
| Authorizing Official | ||||
| Project Director |