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Tutorial: Grant Evaluation Report

Sisters of Mercy of North Carolina Foundation, Inc.
Grant Evaluation Report

Use the sample Evalutation Report Form to report grant usage. Hover your mouse over the links for helpful tips.

Organization Name: _____________________

Address: _____________________________

Contact Person: _______________________

Title: _______________________________

Telephone: __________________________

Email: _______________________________

Please refer to your Evaluation Report notification letter to complete the information below:

Report Due Date: _______________________

Approval Date of Grant: __________________

Amount of Grant: $ _____________________

Payment Schedule: _____________________

Grant #: _______________________

Type of Report: □ Final  □ Interim

Telephone: __________________________

Email: _______________________________

Please refer to the Evaluation Plan that was approved with your Grant Application.

1. What did you propose to accomplish for the target population with this request?




Did you accomplish your original intent? Yes □  No □  If no, tell us what prevented your success in the Comments field:




2. How many unduplicated individuals were served during the past year?   ________

2. How many individuals did you expect to serve according to your Evaluation Plan?   ________

If the participation level you are reporting varies significantly from what you indicated in your Evaluation Plan, please provide some information explaining the variance in the Comments field below.




3. What activities/services were provided that helped move participants toward the outcomes that were proposed in your Evaluation Plan? Include the frequency of the activities/services and the number served.




4. Provide the actual result for each of the outcomes you proposed in the Evaluation Plan submitted with your grant application. Select the Outcome Category that you expected to change (Knowledge, Skill, Condition, Behavior, or Other) and state the corresponding Outcome and Method of Measurement.

If the outcome results you are reporting vary significantly from what you indicated in your Evaluation Plan, please provide some information explaining the variance in the Comments field below.

Eval Plan Estimate   Actual Result   Category   Outcome Method of Measurement
%   %          
%   %          
%   %          




5. What did you learn? Did you encounter any challenges or opportunities during the grant term that resulted in your organization doing business differently? What would you tell others who are involved in a similar program or effort?




6. Has the program or project contributed to systemic change? □ Yes  □ No

  • If yes, name the "system," such as education, healthcare, social service, etc. and;
    System: ___________

  • Indicate what barriers (specific, problematic policies, procedures, commonly held beliefs or common practices) have been altered or removed within this system.
    Barriers removed: ___________

  • How have accessibility and/or opportunity improved or increased within this system as a result of program or project efforts?



  • Longer-term impact: If applicable, what are the expected organizational, community-level, or systemic changes that will result in improved conditions and quality of life for your target population beyond this grant term?



7. Were additional funds or in-kind support leveraged as a result of this funding?




Please refer to the Instructions that accompanied the Evaluation Report notification letter to determine the amount paid to your organization this past year.

For purposes of this report, the Foundation is only evaluating the $_______ paid to your organization this past year. Your numbers below should reflect only that amount. If there are questions about how grant funds should have been spent, please review the Grant Award Letter to your organization.

Multi-year grants only: Please note that this Evaluation Report must be approved by the Foundation, including a possible site visit, before any additional grant funds will be released to your organization.

Expense Items Amount Percent
Personnel: $
Subtotal: $ %
Other Operating: $
Subtotal: $ %
Building Renovation and/or Equipment Purchase: $
Subtotal: $ %
Total: $ 100%

If a balance exceeding $2,500 remains at the end of the grant term, please contact the Foundation to make arrangements to return the remaining balance or send a letter via U.S. Mail signed by your Chief Executive Officer requesting permission to retain the fund balance. The letter should explain the reasons for the balance and how the organization proposes to use the remaining funds. Note that the Foundation's decision on remaining balances, if any, will be communicated to the organization in writing.

I certify that the grant funds have been expended consistent with the terms of the original grant award and as reported above. I agree to supply substantiation of any expenditure greater than $500.00 upon request.

Name _______________________________________ Date: _______________
Chief Executive Officer

(A typed name is acceptable for email submission and an original signature is required for hard copy submissions.)

The information that you will need to complete the items in the box below can be found in the Foundation's letter to your organization requesting submission of the Evaluation Report.

Completion of this Report will require reference to the original Evaluation Plan that was submitted and accepted as part of your Grant Application.

Referring to your original Evaluation Plan, restate your response to Question #1 of the Plan.

If you were unable, or only partially able to accomplish your purpose, please give us a brief description of what prevented your success.

If you accomplished what you intended to, no comments are necessary.

We would like the actual number of individuals served by the program or organization. When providing an unduplicated number, count any individuals who may have received services multiple times as one individual.

Referring to your original Evaluation Plan, restate the proposed number from Question #2.

Refer to your original Evaluation Plan and respond to this question by indicating the actual activities that were provided, the frequency and/or duration, and how many individuals were served through each activity.

If this request was for equipment or renovation, restate the proposed timeline and include actual dates of accomplishment.

Refer to your original Evaluation Plan, Question #4. Copy your projected outcome percentage(s) onto the first column "Eval Plan Estimate" for each outcome proposed.

Indicate the actual outcome percentage in this column for each outcome.

Referring to your original Evaluation Plan, select the category(ies) that you chose for your outcome(s).

Referring to your original Evaluation Plan, copy the proposed outcome description into this column.

State the measurement tool(s) that you used to verify the outcome(s).

You need only comment here if your outcome results were substantially different than your estimate (over or under). If so, briefly describe the reason for the variance.

Hopefully you were able to identify ways in which you could improve the services provided or the manner in which you measure impact. Perhaps you encountered unexpected barriers or opportunities during the year; how did you respond? If someone else were engaged in a similar effort, what advice (or caution) would you offer?

Systemic change occurs when a policy, procedure, commonly held belief or common practice within a community, which has historically created a barrier to certain quality of life benefits, is changed or removed resulting in increased accessibility and opportunity.

If you suspect, or know based on published research of other, similar programs that the services you provided with this grant will have impact beyond this grant term, please offer a brief description. For example, a school-based intervention may have impact on student behavior and grade improvement during the grant term, but a long-term impact may be improvement in graduation rates or lowered drop-out rates within the school system.

Please let us know if you were able to use this grant as a challenge or match for additional support. In addition, let us know if this grant influenced a positive decision from any other funders.

The expense items and amount should closely resemble the Budget Form submitted and approved in your original Grant Application.

This amount is identified in the Instructions that accompanied the Letter of Notification of Evaluation Report Due.

If you have a remaining grant balance in excess of $2,500, you must notify the Foundation in writing via U.S. Mail. The letter must contain the original signature of the organization's Chief Executive Officer or Board Chairperson. The letter must explain the reason for the balance and identify the organization's intent to return the remaining funds or request authorization to retain the balance. Foundation staff will communicate to you in writing the procedure for return of the funds, or a decision regarding the request to retain the balance.

Please refer to the Instructions that accompanied the Letter of Notification of Evaluation Report Due to determine if a hard copy submission is required