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Upper Red Lake
Area Association

Community Grant Report Form

Organization Name*

Grant Program Name*

Grant Recipient Organization*

Organization Address

Country/Region*

Address*

City*

Zip / Postal code*

Primary contact name*

Email*

Phone*

Grant Amount Awarded*

Grant Award Date*

Month

Day

Year

Reporting period (from-to)*

Project Name*

Project Summary (how funds were used)*

Outcomes and Community Impacts (results, people served, events, etc.)*

Financial Summary and Expenditures (brief itemization and totals)*

Challenges and Lessons Learned*

Authorized Representative Name*

Title*

Today's Date*

Month

Day

Year

Digital Signature

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