Project title

Name

First Name

Last Name

Position

School

Email address

Phone number

(###)

###

####

Grant Amount:

Date Received

1. Were other schools/organizations or individuals involved in any aspect of the project?

YES

If YES, please specify who was involved and the nature of the involvement.

2. How many students (by grade/class/team) and/or teachers were served by this project?

3. Remains incomplete?

If YES, please explain and tell us your completion timetable.

4. Met?

Outline any changes that were made and the reasons for making them?

5. Impact?

Please provide a description of successes/failures:

6. Please share with us any newsworthy events concerning the program/project.