New York/new Jersey Area Common Report Format (Page 2 of 4) in pdf

New York/new Jersey Area Common Report Format Page 2

Report Form

New York/New Jersey Area

Common Report Form Cover Sheet

(Please feel free to make copies of this form or generate this one-page cover sheet on your computer.)

Funder receiving report:_____________________________________________________________

Name of organization completing report. Please list exact legal name.

________________________________________________________________________________

Address of organization:_____________________________________________________________

_________________________________________________________________________________

Telephone number:_________________________________________________________________

FAX number:______________________________ E-mail address:__________________________

Executive Director:_________________________________________________________________

Contact person and title (if not executive director):________________________________________

Have there been any changes to your organization’s IRS 501 (c)(3) not-for-profit status since your

request for this grant? (yes or no):______________ If yes, please explain:

_________________________________________________________________________________

Project name or brief project description:________________________________________________

_________________________________________________________________________________

Check one: General operating_____ Project support_____ Other (please specify)_______________

Grant amount: $_____________________Grant Period: from______________to_______________

Date of report: __________________________ Report due date: ____________________________

Dates covered by this report: from________________________to___________________________

Check one:

This is an interim report_____

This is a final report_____

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New York/new Jersey Area Common Report Format Page 2