Revised 8/22/00
Quarter ending:
pSept. 30, 2000
Alaska Commission on Aging
pDec. 31, 2000
Home and Community Based Care
pMarch 31, 2001
ADRD Education and Support
pJune 30, 2001
Quarterly Program Report
SFY 2001
Grantee Agency: _______________________________________________________________
Project Title: __________________________________________________________
Grant # ________________
Prepared By: ________________________________________________ P hone # ________________
I hereby certify that I have reviewed this report and compared it against
project records to assure that all figures and information are correct.
_____________________________________________ _____________
Authorized Signature
Date
Phone #
Program Narrative: Describe outreach activities for program elements including support groups, efforts to
collaborate with other agencies, etc.
Describe issues that affect service delivery and efforts to address these issues.
List any new or innovative activities that could be shared with other grantees through the ACoA newsletter.
Please provide a summary of any client outcome data compiled this quarter.
1
G:\ACoA\SFY01 NEW FORMS\ FY01 HCB forms instructions