North Georgia EMC Roundup Grant Completion Form

Congratulations in completing your project. Please complete this form after you have used the grant funds provided by North Georgia EMC's Round Up Program.

Organization Name: *

Your Name: *

Your Email Address: *

Organization Primary Address: *

City: *

State:

Organization Telephone Number: *

What was the title of your grant? *

How much money were you awarded? *

Is your organization a public high school, middle school, or elementary school? *

Yes

No

Please describe the funded project. Be concise. *

What measurable differences did the funded project make for your organization and/or those served by the project? Be concise, but please provide data (i.e. number of individuals served, pounds of food purchased, number of blankets provided to homeless individuals, etc.) *

What did you learn, and what would you tell another group who was going to do a similar project? Did you encounter any problems? If so, what were they? *

Please upload a photo (if available) that demonstrates the funded project or your organization's work (i.e. a photo of meals being served to needy people or a photo of children running on a new asphalt track). We may use your photo for our marketing and publicity.

I understand the following: 1) By uploading the photo, I am granting permission to both North Georgia EMC and the Community Foundation of Northwest Georgia to use the photo in their marketing and publicity without compensation. 2) I am authorized to give the required permission. 3) I understand that some photos may require a signed photo release from parties pictured in the photograph, and I am certifying that my organization has a signed release on file, or that a signed release is not necessary for the uploaded photo. *

Yes, I understand. I grant permission to use the photo, I have authority to grant permission, and we've taken care of any photo release requirements.

No

Please rank North Georgia EMC's Round Up grant process on a scale of 1 (very poor) to 5 (excellent). *

Please rank North Georgia EMC's Round Up staff support/performance on a scale of 1 (very poor) to 5 (excellent). *

Thank You!

Thank you for taking the time to complete North Georgia EMC's Round Up Grant Completion Form. We look forward to working with you again in the future!