ProVision Fund
Final Report and Funding Request
Provision Grant Number
*
Funds Payable to
*
Name of Program
*
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Program Start Date
*
-
Month
-
Day
Year
Date
Program End Date
-
Month
-
Day
Year
Date
Please select type of request
*
Final 25% of total grant amount for current year
Other final grant amount (for other please enter amount and comment/explanation)
Next year's previously approved grant amount
Other Amount
*
Other Comment/Explanation
*
Amount of Approved Grant
*
Amount to be Paid
Objective of Program
*
Outcome and Achievements
*
Learnings and Celebrations to Share with Others Considering a Similar Project
*
Project Income
Specify
Amount
Community of Faith financial support
Other United Church of Canada funding (please specify)
Other Grants (please specify service)
Fundraising
Funding from Partners
Other (please specify)
Amount Received from ProVision
Total Income
Project Expenses
Specify
Amount
Staff / Contractors
Materials and Supplies
Promotion and Education
Rent
Other (please specify)
Other (please specify)
Total Expenses
Balance
Optional: Briefly add any additional comments to accompany the financials entered above.
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