Forest Grove Public Arts Commission
Project Summary & Evaluation
(For reimbursement of expenses for mini-grant recipients)
(To be submitted within 30 days after funded event or grant money is forfeited)
Project Name: ________________________________________________________________________
Contact Name(s): _____________________________________________________________________
Contact Phone(s): H:________________________ W:______________________________
Address: ____________________________________________________________________________
E-Mail Address: ______________________________________________________________________
Description of Project (Attach photos, and promotional information, if possible. Attach sheet, if desired):
Date Completed:________________________
Total Grant Approved by PAC:
not to exceed $500
Actual Expenses:
Personnel: (describe) ________________________________________ Total Cost: ________________
Materials & supplies: (describe) ________________________________ Total Cost: ________________
Marketing & publicity: (describe) ________________________________ Total Cost: ________________
Other Expenses: (describe) ___________________________________ Total Cost: ________________
Total amount of reimbursement request: (not to exceed approved grant) __________________
Name and address for reimbursement by check (only if different from above):
_____________________________________________________________________________
In-kind Contributions: Total $ Amount of In-kind Contribution: ______________
(briefly describe):
Name of organizations that partnered or collaborated with this project:
____________________________________________________________________________________
How many people in the community participated in this project? (if applicable) ____________
How did this project benefit the people of Forest Grove?
Signature(s) _________________________________________________ Date_______________
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