Name: The Town Of High River
Price range: $

Home Town Services Planning and Development Funding Accountability Report for the Community Vitality Fund

Funding Accountability Report for the Community Vitality Fund

The Community Vitality Fund provides financial resources and builds capacity to execute priority community projects.

Each of the defined groups shall be subject to the following conditions relative to their funding request;

An Income & Expense Statement for the Initiative for which funds were applied for
A paragraph explaining how the funds were expended
The report is due within 60 days of the completion of the initiative
All conditions must be satisfied before any further applications will be considered
This report must be signed by two executive officers of the group

Project & Contact Information

Project / Initiative Title

Group Name

Website (if applicable)

Project Mailing Address

Address 1

City

ZIP / Postal Code

Amount Requested

Total Grant Received

Contact Information

Primary Contact

Primary Contact First Name

Primary Contact Last Name

Primary Contact Phone

Primary Contact Email

Secondary Contact

Secondary Contact First Name

Secondary Contact Last Name

Secondary Contact Phone

Secondary Contact Email

Initiative / Project Information

How did you advertise the project was Community Vitality Funded?

Date(s) Initiative or Project took place:

What were the Community Vitality Funds used for?

(CVAC does not fund wages or donations to other groups)

Provide an update on the goals and activities of the project. Did you meet the objectives outlined in the application?

Was the project / initiative successful?

If you received partial funding, how did that impact your project / initiative?

Please indicate the number of High River citizens you were able to serve with your initiative / project:

Please provide an update on how matching contributions were utilized:

(volunteer hours, material donations, etc)

Expenses for the Initiative / Project (please provide copies or receipts)

*If you did not spend the full amount, the remaining funds must be returned

Expenses for the Initiative / Project

Item #1 Expense:

Item #1 Actual Cost:

Item #2 Expense:

Item #2 Actual Cost:

Item #3 Expense:

Item #3 Actual Cost:

Item #4 Expense:

Item #4 Actual Cost:

Item #5 Expense:

Item #5 Actual Cost:

Item #6 Expense:

Item #6 Actual Cost:

Item #7 Expense:

Item #7 Actual Cost:

Item #8 Expense:

Item #8 Actual Cost:

Item #9 Expense:

Item #9 Actual Cost:

Item #10 Expense:

Item #10 Actual Cost:

Total Expenses

Expense Receipts

Income for the Initiative / Project

Item #1 Income:

Item #1 Actual Cost:

Item #2 Income:

Item #2 Actual Cost:

Item #3 Income:

Item #3 Actual Cost:

Item #4 Income:

Item #4 Actual Cost:

Item #5 Income:

Item #5 Actual Cost:

Item #6 Income:

Item #6 Actual Cost:

Item #7 Income:

Item #7 Actual Cost:

Item #8 Income:

Item #8 Actual Cost:

Item #9 Income:

Item #9 Actual Cost:

Item #10 Income:

Item #10 Actual Cost:

Total Revenue

Please provide an anecdotal example of your initiative/ project success and attach a photo if available

Declaration

I declare that all of the information in this report is accurate and complete, and that the report is made on behalf of the organization named on page one with its full knowledge and consent.

Report Completed By:

Report Completed By First Name

Report Completed By Last Name

Report Completion Date:

Executive Officer #1 Name:

Executive Officer #1 First Name

Executive Officer #1 Last Name

Executive Officer #1 Signature:

Executive Officer #2 Name:

Executive Officer #2 First Name

Executive Officer #2 Last Name

Executive Officer #2 Signature:

The information collected via this form is being collected by the Town of High River pursuant to legislation governing the information handling practices of the Town of High River, specifically Sections 4(a) and (c) of the Protection of Privacy Act (Alberta), the Municipal Government Act (Alberta), and other legislation or bylaws governing the municipality, as may be applicable. By submitting this form, you acknowledge that in accordance with Section 20(2)(a) of the Access to Information Act (Alberta), your name, address, and other details related to your request will be used to process your request. Should you have any questions relating to the collection or disclosure of your personal information, please contact the Privacy Officer for the Town of High River at ATIPP@highriver.ca or 403-652-2110.

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Town of High River Contact

309B Macleod Trail S.W., High River, Alberta

Monday to Friday 8:30am - 4:30pm (Closed on statutory holidays)

jdunsmore@highriver.ca

403-603-3515

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