Gloucester County Cultural & Heritage Commission

Checklist for Completion of Final Report FY16

____ Organization Narrative

____ Income/Revenue Report

____ Expense Reports: Form A Form B

____ Certification Signatures (2)

____ Collateral Material: 1 copy each ____ programs, brochure, press releases, fliers, etc with contractual credit line

____ if applicable, 2 photographs of program/project (email to [email protected])

Grantee Organization:

Person submitting final report:

Title:

Day phone #:

FINAL REPORT DUE NO LATER THAN FRIDAY, DECEMBER 16, 2016 NO EXCEPTIONS

Final reports with original signatures can be mailed to the Gloucester County Cultural & Heritage Commission, c/o Diane Macris at:

Gloucester County College 1400 Tanyard Road Sewell, NJ 08080

Or drop off at: GLOUCESTER COUNTY COLLEGE, COLLEGE CENTER, OFFICE 102

PHONE: 856-464-5214 EMAIL: [email protected]

Gloucester County Cultural & Heritage Commission 1 NJSCA FY16 Re-grantee Final Report

Name of Organization:

____ General Operating Support ____ Special Arts Project

Organizational Narrative Use additional pages if necessary to answer any of the questions.

A. Programming

1. Give a brief description of how the C&H Grant award was used:

2. List the dates of performance/programs given and the locations of each:

3. Briefly evaluate the organization project. a. Was all major program/project goals met? If no, explain.

b. What methods were used to evaluate the program/project? How is success measured?

4. State any improvement on the quality of programming:

B. Public Value & Benefit: Participation/Accessibility

1. Attendance: list the estimated numbers who attended the organization’s programs/project.

a. Adults: b. Youth (under 18) Total live attendance (a+b)

c. Number of artists engaged:

2. For the figures provided above, describe below the composition of your audience in terms of race, ethnicity, age, income level, education level, and disabilities, etc the best you are able.

Gloucester County Cultural & Heritage Commission 2 3. List the Gloucester County communities this funding served:

4. Briefly describe the impact of your organization/project on the community:

5. Describe specifically the process that was used to make the community aware of the project for which you received Special Arts Project Funding. Were your organization’s marketing efforts successful?

6. Enclose copies of publicity such as press releases, press clippings, programs, brochures, and advertisements that show compliance with the publicity agreement as stated in the contract with Gloucester County. NEW: submit 2 photos from your project or program and email to [email protected]. Please include signed waiver from participant so we or the NJSCA can use for publicity.

7. List any workshops/seminars for non-profits that your organization attended in the last grant period that were sponsored by the GCC&H or other arts organizations.

B. Finances

1. Did the organization experience an operating deficit for this grant period? If yes, explain how this deficit will be addressed.

List the $$ value of the in-kind donations and services for your project/program.

Gloucester County Cultural & Heritage Commission 3 Gloucester County Cultural & Heritage Commission NJSCA FY16 Re-Grantee Final Report

GRANTEE: GRANT CATEGORY: □ General Operating Support □ Special Project Support GRANT PERIOD: January 1, 2016 through December 31, 2016

Note: This budget page is based on your actual grant award.

EXPENSES BUDGETED ACTUAL AMOUNT FINANCE CHART A 1/16– 12/16 1/16 – 12/16 from C&H

PERSONNEL: 1. Administrative 2. Artistic 3. Technical/Production

OUTSIDE FEES & SERVICES 4. Artistic 5. Other

OTHER OPERATING EXPENSES 6. Space Rental/Mortgage 7. Travel/Transportation 8. Marketing/Advertising 9. Facility Maintenance 10. Telephone/Postage 11. Printing/Copying 12. Materials/Supplies 13. Insurance 14. Technical/Production 15. Other [Please itemize if Over 5% of total budget] Total cash expenses

CERTIFICATION: We certify that the above information is true and correct and that all expenditures were incurred solely for the purpose of this grant.

Project/Program Director’s Signature Date

Gloucester County Cultural & Heritage Commission 4

Fiscal/Budget Officer’s Signature Date

Gloucester County Cultural & Heritage Commission NJSCA FY16 Re-Grantee Final Report

EXPENDITURES: FINANCE CHART B

BUDGETED ACTUAL AMOUNT 1/16 – 12/16 1/16 – 12/16 from C&H

OUTSIDE FEES & SERVICES Artistic: List artists, companies, etc 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Total:

OTHER: 1. 2. 3. 4. 5, Total:

OTHER OPERATING EXPENSES Marketing/Advertising: 1. 2. 3. 4. 5. 6. Total:

OTHER: Itemize if over 5% 1. 2. 3. 4. 5.

Gloucester County Cultural & Heritage Commission 5 6. Total:

Gloucester County Cultural & Heritage Commission NJSCA FY16 Re-Grantee Final Report INCOME

ORGANIZATION: PERSON COMPLETING REPORT: Name Title

INCOME BUDGETED ACTUAL Itemize each category: 12-month period 12-month period List Sources and Amounts 1. Corporate & Foundation Contributions

2. Government Other than Gloucester County Cultural & Heritage Commission

3. Private Contributions

4. Other [Itemize]

5. Earned Income [Itemize]

6. Application Cash

SUBTOTAL:

7. Grant received from Gloucester County Cultural & Heritage Commission

TOTAL INCOME