Grantee Reporting Form

Items marked with an * are required.

Organization Name

Grant #

Amount of Grant

Grant Period

How many women were served through this grant?

How many children were served through this grant?

Based on your selected objective (possible objectives listed here: (1) empower parents and caregivers with information and support to assure family health, (2) bring culturally relevant information and services into communities, (3) remove barriers to healthcare, (4) address community health priorities and delivery system gaps), what were the primary successes of your efforts related to this grant? Please describe specifics related to desired outcomes detailed in your original application. For example, if your project provided culturally relevant information services to communities, what were they, how did it happen, and what impact did it have?

What were the primary successes of your efforts related to this grant?

What challenges did you face in your efforts and how did you overcome them?

What are your plans for sustaining this work?

Name of Person Submitting Form

Title of Person Submitting Form

Date

Acceptance

I certify that the information provided is accurate and complete to the best of my knowledge.

Note: send final financial reports to info@hfoc.org