Sample MZHF Grant Reporting Form

Grant Reporting Form: The below information is for reference only. All reports must be submitted online using the application account login information.

Organization and Project Name	MZHF Grant Number
Contant Person	Title
Report date	Grant Amount Grant Period
Phone	Email
Address

• Briefly summarize the project, activities conducted, unmet needs addressed, and the population benefiting.
• Restate each goal (measurable outcomes) from your proposal, and provide the data from your evaluation assessing whether or not the goal was met. For any goals not met, describe why not.
• Provide a breakdown of grant expenditures and explain any significant variances as compared to the original grant request.
• What, if any, are the next steps for the project? What are the associated funding requirements and potential sources of funds?