Local Government Authorities - Active Living Grants

Pyrenees Shire Council Community Grants Program Activity Report Form

Congratulations on completing your Pyrenees Shire Community Grant Project.

Submitting this Activity Report is a requirement of receiving a Community Grant and is an important part evaluating the Community Grants.

To acquit the Community Grant provided to your organisation you need to submit this Activity Report by 30th June in the financial year you received the funding.

Details of how can be found at the end of this form.

Any queries about completing this form can be directed to the Pyrenees Shire on 03 5349 1100

Organisation details

Funded Organisation:

Name of person completing this form:

Grant Round: Round: May is round 1, October is round 2 Financial Year:

Position: Telephone: Address:

Email:

Updated October 2016 Your Project Please could you provide the following information on your project, activity or event:

*Please use a success rating of: 1 - Highly successful 2 - Successful 3 - Somewhat successful 4 - Not very successful 5 - Not at all successful

PROJECT NAME LOCATION No Attending SUCCESS Rating*

Your expenditure Please attach a copy of all receipts to this report.

Please provide a breakdown of your expenditure of the Community Grant Funding provided by the Pyrenees Shire (including your contribution).

AREA OF EXPENDITURE Amount e.g. Performers, marketing, advertising etc.

TOTAL PROJECT COST $ Less Community Grants Program Funding - $ Total contribution by your organisation, sponsors & other $ funding

Are there any unspent Community Grant Funds? Double click to check box YES NO

Event promotion

Updated October 2016 Which of the following activities did you undertake to promote your activities or events? Double click to check box

Media releases YES NO Flyers / brochures YES NO Interviews with local radio / newspapers YES NO Posters YES NO Direct mail to local groups YES NO Invitation to Ward Councillor to participate YES NO

Other, please specify below

Do you have any suggestions or further comments you would like to make about the Community Grants?

Please forward this form to: Community Grants Activity Report Pyrenees Shire Council 5 Lawrence Street Beaufort Vic 3373

Or email to: [email protected]

Updated October 2016