<p> Gloucester County Cultural & Heritage Commission</p><p>Checklist for Completion of Final Report FY16</p><p>____ Organization Narrative</p><p>____ Income/Revenue Report</p><p>____ Expense Reports: Form A Form B</p><p>____ Certification Signatures (2) </p><p>____ Collateral Material: 1 copy each ____ programs, brochure, press releases, fliers, etc with contractual credit line</p><p>____ if applicable, 2 photographs of program/project (email to [email protected])</p><p>Grantee Organization: </p><p>Person submitting final report:</p><p>Name: </p><p>Title: </p><p>Day phone #: </p><p>Date: </p><p>FINAL REPORT DUE NO LATER THAN FRIDAY, DECEMBER 16, 2016 NO EXCEPTIONS</p><p>Final reports with original signatures can be mailed to the Gloucester County Cultural & Heritage Commission, c/o Diane Macris at:</p><p>Gloucester County College 1400 Tanyard Road Sewell, NJ 08080</p><p>Or drop off at: GLOUCESTER COUNTY COLLEGE, COLLEGE CENTER, OFFICE 102</p><p>PHONE: 856-464-5214 EMAIL: [email protected]</p><p>Gloucester County Cultural & Heritage Commission 1 NJSCA FY16 Re-grantee Final Report</p><p>Name of Organization: </p><p>____ General Operating Support ____ Special Arts Project</p><p>Organizational Narrative Use additional pages if necessary to answer any of the questions.</p><p>A. Programming</p><p>1. Give a brief description of how the C&H Grant award was used:</p><p>2. List the dates of performance/programs given and the locations of each:</p><p>3. Briefly evaluate the organization project. a. Was all major program/project goals met? If no, explain.</p><p> b. What methods were used to evaluate the program/project? How is success measured?</p><p>4. State any improvement on the quality of programming:</p><p>B. Public Value & Benefit: Participation/Accessibility</p><p>1. Attendance: list the estimated numbers who attended the organization’s programs/project.</p><p> a. Adults: b. Youth (under 18) Total live attendance (a+b) </p><p> c. Number of artists engaged: </p><p>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.</p><p>Gloucester County Cultural & Heritage Commission 2 3. List the Gloucester County communities this funding served:</p><p>4. Briefly describe the impact of your organization/project on the community:</p><p>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?</p><p>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. </p><p>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.</p><p>B. Finances</p><p>1. Did the organization experience an operating deficit for this grant period? If yes, explain how this deficit will be addressed.</p><p>List the $$ value of the in-kind donations and services for your project/program.</p><p>Gloucester County Cultural & Heritage Commission 3 Gloucester County Cultural & Heritage Commission NJSCA FY16 Re-Grantee Final Report</p><p>GRANTEE: GRANT CATEGORY: □ General Operating Support □ Special Project Support GRANT PERIOD: January 1, 2016 through December 31, 2016 </p><p>Note: This budget page is based on your actual grant award.</p><p>EXPENSES BUDGETED ACTUAL AMOUNT FINANCE CHART A 1/16– 12/16 1/16 – 12/16 from C&H </p><p>PERSONNEL: 1. Administrative 2. Artistic 3. Technical/Production </p><p>OUTSIDE FEES & SERVICES 4. Artistic 5. Other </p><p>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 </p><p>CERTIFICATION: We certify that the above information is true and correct and that all expenditures were incurred solely for the purpose of this grant.</p><p>Project/Program Director’s Signature Date</p><p>Gloucester County Cultural & Heritage Commission 4</p><p>Fiscal/Budget Officer’s Signature Date</p><p>Gloucester County Cultural & Heritage Commission NJSCA FY16 Re-Grantee Final Report</p><p>EXPENDITURES: FINANCE CHART B</p><p>BUDGETED ACTUAL AMOUNT 1/16 – 12/16 1/16 – 12/16 from C&H </p><p>OUTSIDE FEES & SERVICES Artistic: List artists, companies, etc 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Total: </p><p>OTHER: 1. 2. 3. 4. 5, Total: </p><p>OTHER OPERATING EXPENSES Marketing/Advertising: 1. 2. 3. 4. 5. 6. Total: </p><p>OTHER: Itemize if over 5% 1. 2. 3. 4. 5. </p><p>Gloucester County Cultural & Heritage Commission 5 6. Total: </p><p>Gloucester County Cultural & Heritage Commission NJSCA FY16 Re-Grantee Final Report INCOME</p><p>ORGANIZATION: PERSON COMPLETING REPORT: Name Title</p><p>INCOME BUDGETED ACTUAL Itemize each category: 12-month period 12-month period List Sources and Amounts 1. Corporate & Foundation Contributions</p><p>2. Government Other than Gloucester County Cultural & Heritage Commission</p><p>3. Private Contributions</p><p>4. Other [Itemize]</p><p>5. Earned Income [Itemize]</p><p>6. Application Cash</p><p>Gloucester County Cultural & Heritage Commission 6</p><p>SUBTOTAL: </p><p>7. Grant received from Gloucester County Cultural & Heritage Commission</p><p>TOTAL INCOME </p><p>Gloucester County Cultural & Heritage Commission 7</p>