Form 4971 - Competitive Grant Assistance Program (Cgap) Narrative Report (Nr)

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Michigan Department of Treasury
4971 (Rev. 11-12)
Competitive Grant Assistance Program (CGAP) Narrative Report (NR)
Completion is a condition of the grant.
SEE PAGE 2 FOR INSTRUCTIONS
PART 1: PROJECT INFORMATION
1. Grant Number
2. Project Title
3. Primary Local Unit Name
4. Telephone Number
5. Mailing Address
City
State
ZIP Code
6. Period Start Date
7. Period End Date
8. Report Type
9. Percentage Completed
10. Estimated Completion Date
%
Quarterly
Final
PART 2: PROJECT NARRATIVE
11. Provide a brief outline of the work accomplished during the reporting period (or grant period, if this is the final report) relative to the proposed work
plan and timeline.
12. Provide a brief outline of the work to be completed during the subsequent reporting period.
13. Provide a brief description of any problems or delays, real or anticipated, experienced.
14. For FINAL reports only, provide a description of the project accomplishments and any unanticipated benefits/difficulties experienced while
completing the project.
15. For FINAL reports only.
Are you willing to complete a follow-up questionnaire with Treasury one year after the grant project is finalized?
Yes
No
PART 3: CERTIFICATION
I hereby certify that all statements in this report, including all supplemental information, are true, complete and accurate to the best of my knowledge.
Printed Name of Primary Local Unit Representative
Title
Signature of Primary Local Unit Representative
Date

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