Template:FDC impact report form v1

Please do not edit the FDC impact report form. Instead, if you have comments or feedback, we welcome that on the talk page.

Purpose of this document

This is the report that recipients of funding will be required to fill out to report on the use of funds and their progress toward established goals.

FDC Impact Report

Legal name of affiliate organization (national chapter, sub-national chapter, thematic organization, or third-party group):
Contact name and title (position):
Contact username or email:
Grant title:
Amount received (in USD):
Actual amount spent (in USD):
Time Frame: [Start: mm/dd/yy] – [End: mm/dd/yy]

Summary

• Key messages from the previous year's grant and funds used

Financial Summary

Please provide a detailed budget or outline costs in the format below.

Revenues	Budgeted	Actual	Explanation of variances from plan

Operating Expenses	Budgeted	Actual	Explanation of variances from plan

Project Expenses	Budgeted	Actual	Explanation of variances from plan

Progress against previous year's goals/objectives

Activities executed	Strategic objectives	Progress against measurable indicators	Explanation of variances from plan (if no plan, N/A)

Lessons Learned

What were your major accomplishments in the past year and how did you help to achieve movement goals? What enabled your success?

What unanticipated challenges did you encounter and how did this affect what you were able to accomplish?

What can other Chapters or entities learn from your experience?

Additional Information

• This section is optional. Please use it to link to any other relevant information that may be helpful.