Grantee Name Contact info for person completing this report (Name) Phone Email Program Name Amount funded for grant period Grant period (mo/yr to mo/yr) Report submission date Grant Uses - Select -Operation Project Support Challenge Grant Capital Expense Other (Specify) Dear Grantees, Please provide information about your experience in implementing the program and summarize the program’s reach, quality, and impact. Report only on data that is reflective of clients and services funded by UWAC funding or add a note to identify what percentage of the program was funded by UWAC funding, if using multiple funding sources. It is recommended that grantees collect data as frequently as possible to aid in your data measurement and reporting processes. When reporting percentages, always include numerator, denominator and calculation explanations (ex: 35 out of 45 surveyed clients (76%) demonstrated positive/negative changes in ___). It is recommended that you refer to the grant application or proposal that was submitted when providing the information below. Primary Objective - Select -Education Health Income Stability Basic Needs 1. Give a brief narrative regarding your program description. 2. List 3-5 accomplishments or progress towards meeting your program goals/objective so far. 3. Describe any delays or challenges in meeting program goals/objectives. 4. Are you on track to meeting the targeted # of program outputs? Explain any reduction or increase in the # of outputs. 5. Describe your client recruitment and referral process. Include sources of referrals and related barriers/challenges. 6. Describe your eligibility criteria for the program client to participate in the post program data collection activities. 7. Describe how you are measuring or capturing any positive changes in Knowledge (K), Skill (S), or Attitudes (A) in unduplicated clients. 8. What are your indicators of outcomes or impact? What data was collected and analyzed? What does the data tell you? 9. How do you use the results of your monitoring efforts to continuously improve the program? 10. Describe any lessons learned and how the program might be improved. 11. Population Served a) Total # of unduplicated Clients Enrolled b) Total # of unduplicated Clients Who Completed the Program (per definition in App/Proposal) c) Total # of unduplicated Clients that DID NOT COMPLETE the program d) Total # of unduplicated Clients That Were Surveyed/Tested/Interviewed/ETC (per eligibility criteria in Q#5 above). e) Total # of unduplicated clients reporting positive changes in (Knowledge, Skill, or Attitudes) 12. What % of your program participants respond to your surveys or other data collection methods regarding outputs or outcomes? 13. Describe how helping the # of clients served is going to move the needle on the community indicators being tracked by UWAC? Submit
