final report form - american medical association最终报告的形式-美国医学协会

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1、FinalReportFormHealthyLivingGrantProgram2011Pleasesubmitthisfinalreportuponcompletionofyourproject.Youwillhaveoneyearfromthedateofyourgrantchecktocompletetheproject.Iftheprojectisnotcompletedbythistime,thegrantrecipientmustnotifytheAMAFoundationinwriting30dayspriortothecompletiondateseekingappro

2、valforano-cost,one-timegrantextensionofsixmonthsfromtheoriginalprojectcompletiondeadline.Suchrequestsmustcontainthefollowinginformation:(1)Thereasonfortheextensionrequest,(2)Expenditurestodateandbudgetremaining,and(3)Proposedexpenditures.RecipientswhodonotsubmitaFinalReportnoranextensionrequestw

3、illbeaskedtoreturntheiroriginalgrantfundstotheAMAFoundation.SubmitFinalReportto:AMAFoundationFax:(312)464-4142(youmaysubmitreportviaHealthyLivingGrantProgramPhone:(312)464-4200mail,faxoremail)515N.StateSt.dina.lindenberg@ama-assn.orgChicago,IL60654RecipientName:CurrentInstituti

4、on:TitleofProject:Address:City,State&ZipTelephone:Fax:E-mail:AwardAmount:Totalnumberofpeopleservedbythisproject:1.Tellusaboutyouractivity.Whowasinvolved?Where,whenandwhattookplace?2.Whatmeasurablegoalsdidyousetforthisprojectandwhatindicatorsdidyouusetomeasureyourperformance?Towhatextentdidyourpr

5、ojectachievethesegoalsandlevelsofperformance?Trytobeasspecificaspossible.3.Whathasbeentheimpactoftheprojectonthepopulationyouserve,yourBoard,staff,and/ororganizationaldevelopment?4.Werethereanyunanticipatedresults,eitherpositiveornegative?Whatdidyoulearnbecauseofthisgrant?5.Arethereplanstosustai

6、ntheproject?Whyorwhynot?6.ProvideyouractualexpenditureswithregardtotheAMAFoundationgrantfunds.Iftherewasanydeviationfromyourproposedbudget,pleasenotethisdifference:7.HastheAMAFoundationgrant:·stimulatednewfundingfromcorporationsand/orfoundations?YESNO·stimulatednewfundingfromindividuals?YESNO·ai

7、dedincollaborationamongcommunityinstitutions?YESNO·increasedvolunteerinvolvement?YESNO·increasedthevisibilityoftheprojectand/ororganization?YESNOPleaseprovideanyfurtherexplanationordetailsaboutanyoftheabovestatements.8.Whats