Twelve Month Report #2

(for use by agencies seeking renewal funding, as invited by VNA)

Complete the following information in Microsoft Word Document format. Attach to an email and send it to: Please answer questions 1-5 concerning your grant that has recently ended. Questions 6-10 address your request for a renewal proposal.

1. Please give a brief overview of the program funded by this grant.
2. Please state your outcome measures as written in your original proposal and address your progress toward achieving each. If any outcome measures were changed, please explain why. If you were unable to accomplish certain outcome measures, what hindered the progress?
3. What internal or external challenges did you face in connection with this project and how did you address these challenges? Has anything changed within your organization as a result of this project?
4. What were the most important lessons learned? For example, what do you think you have done particularly well and what would you have done differently? Has the project added to the knowledge of a subject or the improved delivery of services?
5. Attach a financial report specific to your grant funds, using the same format as the budget in your original proposal.
6. Please provide an overview of the program or activities for which you seek renewal funding.  Have changes been made to the program or activities that was/were funded last year? Has the population served by the program changed?
7. What are your goals for this project?  Please list the specific outcome measures which will demonstrate the impact of the grant (beyond just volume measures). 
8. Please attach a budget that states the amount of your renewal request and outlines how you plan to utilize the grant funds if awarded.  Attach a budget narrative for any projected costs that are not self-explanatory or require detail.
9. Has your organization or the project for which you request funding experienced any of the following since your last grant with VNA?
   • Changes or turnover in management, board or staffing?
   • Changes to tax exempt status or material changes to financial position?
   • Changes to the direction or mission of agency or project?
   If yes, please note the changes and attach appropriate documentation of any changes (e.g. board list, IRS determination letter, etc).
10. Please attach your agency’s most recent organizational budget, audit, and list of major funders.

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