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

New York/new Jersey Area Common Report Form (Crf) Page 2

Report Form

New York/New Jersey Area

Common Report Form Cover Sheet

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______

Philanthropy New York • 79 Fifth Avenue, Fourth Floor • New York, NY 10003-3076

212-714-0699 •

The Council of New Jersey Grantmakers • 101 West State Street • Trenton, NJ 08608 • 609-341-2022 •

New York/new Jersey Area Common Report Form (Crf) Page 2