Fillable Optimist international Childhood Cancer Campaign Matching Grant Final Report

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Optimist international Childhood Cancer Campaign Matching Grant Final Report

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Project Name: ___________________________________________________________________________
Sponsoring Optimist Club or District: _______________________________________________________
Club/District Number: ________________________
Contact Person: _________________________________________________________________________
Mailing Address: _________________________________________________________________________
City: _________________________ State/Province: ____________________________________________
ZIP/Postal Code: ___________________ Country: ____________________________________________
Phone: ______________________________ E-mail: ____________________________________________
Number of Club or District members involved in project _______
Number of Individuals benefited _______
Date project completed From _______ / _______ / _______ to _______ / _______ / _______ .
Estimated project hours: Optimist _______ Other _______
Why did your Optimist Club/District choose to do this Project?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
State the goals of this project in 50 words or less:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Were Project goals met?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
If goals were not met, why not?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Childhood Cancer Campaign
Matching Grant Final Report
What measuring tool was used to consider this project successful?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
List all relevant publicity and promotions:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Outside organizations assisting or cooperating:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Community benefits:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Given your experience, what would you do differently if you were doing this Project again?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Final Financial Statement
Income
Club appropriations . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Outside donations . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Other . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Expenses
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Summary of major activities involved in planning and running the project:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Please include verification of how the raised funds were spent (receipts, copy of donation check,
thank you letter, media coverage, etc) with the Final Report.
Send completed application to:
Optimist International, c/o CCC
4494 Lindell Blvd., St. Louis, MO 63108
Fax: (314) 371-6006 • ccc@optimist.org
Project Name: ___________________________________________________________________________
Sponsoring Optimist Club or District: _______________________________________________________
Club/District Number: ________________________
Contact Person: _________________________________________________________________________
Mailing Address: _________________________________________________________________________
City: _________________________ State/Province: ____________________________________________
ZIP/Postal Code: ___________________ Country: ____________________________________________
Phone: ______________________________ E-mail: ____________________________________________
Number of Club or District members involved in project _______
Number of Individuals benefited _______
Date project completed From _______ / _______ / _______ to _______ / _______ / _______ .
Estimated project hours: Optimist _______ Other _______
Why did your Optimist Club/District choose to do this Project?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
State the goals of this project in 50 words or less:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Were Project goals met?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
If goals were not met, why not?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
What measuring tool was used to consider this project successful?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
List all relevant publicity and promotions:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Outside organizations assisting or cooperating:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Community benefits:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Given your experience, what would you do differently if you were doing this Project again?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Final Financial Statement
Income
Club appropriations . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Outside donations . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Other . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Expenses
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Summary of major activities involved in planning and running the project:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Please include verification of how the raised funds were spent (receipts, copy of donation check,
thank you letter, media coverage, etc) with the Final Report.
Send completed application to:
Optimist International, c/o CCC
4494 Lindell Blvd., St. Louis, MO 63108
Fax: (314) 371-6006 • ccc@optimist.org
Project Name: ___________________________________________________________________________
Sponsoring Optimist Club or District: _______________________________________________________
Club/District Number: ________________________
Contact Person: _________________________________________________________________________
Mailing Address: _________________________________________________________________________
City: _________________________ State/Province: ____________________________________________
ZIP/Postal Code: ___________________ Country: ____________________________________________
Phone: ______________________________ E-mail: ____________________________________________
Number of Club or District members involved in project _______
Number of Individuals benefited _______
Date project completed From _______ / _______ / _______ to _______ / _______ / _______ .
Estimated project hours: Optimist _______ Other _______
Why did your Optimist Club/District choose to do this Project?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
State the goals of this project in 50 words or less:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Were Project goals met?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
If goals were not met, why not?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
What measuring tool was used to consider this project successful?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
List all relevant publicity and promotions:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Outside organizations assisting or cooperating:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Community benefits:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Given your experience, what would you do differently if you were doing this Project again?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Final Financial Statement
Income
Club appropriations . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Outside donations . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Other . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Expenses
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
. . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________
Summary of major activities involved in planning and running the project:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Please include verification of how the raised funds were spent (receipts, copy of donation check,
thank you letter, media coverage, etc) with the Final Report.
Send completed application to:
Optimist International, c/o CCC
4494 Lindell Blvd., St. Louis, MO 63108
Fax: (314) 371-6006 • ccc@optimist.org
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Optimist international Childhood Cancer Campaign Matching Grant Final Report

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Completed 29 January 2020

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