GRANT REPORT FORM

(Please complete this form and enclose it with your next grant request.)

Name of Organization:
Name of Program:
Contact Person/Title:
Telephone:	Fax:	Email:
Date Grant Received:	Amount of Grant:	Grant Period:

Major activities and accomplishments, during the grant period:

2. Any problems or special concerns:

3.	Significant results:

4.	Specific use of funds received from ACC, during the grant period:

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ACC/Grant Documents/Master funding Documents/grantreportform Revised 4/30/20