Mercer County Cultural and Heritage Commission
History Regrant
FY16 Final Report Form
General Operating Support (GOS)
Special Projects (SP)
Deadline: June 30, 2016 ***
Grantee:
Grant Type: SP
Grant Amount
$
Please complete all pages of the Final Report Form including the Special Projects Budget sheet. ALSO Provide a narrative
of no more than three pages that addresses questions 1-12 and summarizes your organization's accomplishments in
carrying out its grant-funded activities. Use the bold headings below to organize your narrative. Also, complete and attach
the Activities Chart and Budget sheet. Report on the grant period 9/1/15- 8/31/16. SP grantees only need to report on
those projects supported by this grant. GOS grantees should report on all organizational operations and programs (do
not include capital activities).
Programs
1. Enter the total number of public history-related activities/events supported through this grant. Briefly describe these
activities in the narrative.
2. In your narrative, describe how the project/s funded through Mercer County’s History Regrant fit in with the History
Programming goals of your organization.
Describe any challenges in implementing your goals and efforts to meet those challenges. If the goals were not met,
describe obstacles faced. Please note all significant changes to the project’s content, timing, scope, or number of
activities.
Identify any important awards or recognition received by your organization this year. Please describe all positive
responses to or outcomes of Regrant-funded projects.
Finances
3. Actual Cash Revenues – Enter the FY16 Actual Cash Revenues specific to the Special Project (SP).
4. Actual Cash Expenses – Enter the FY16 Actual Cash Expenses specific to the Special Project (SP).
5. Actual Cash Match – Enter the FY16 Actual Cash Match specific to the Special Project (SP).
Planning
6. Describe in the narrative all progress made in implementing your organization’s long-range strategic plan during the
past twelve months; or, if progress was impeded, describe issues or challenges that affected implementation of the
plan. If your organization is currently engaged in development of a new plan, describe the process and status.
Briefly describe any major issues or trends that have surfaced in any of your planning activities.
Partnerships/Collaborations
7. If applicable, please enter the total number of collaborations and partnerships you engaged in with other organizations
for the Regrant-funded project/s. Please describe these partnerships in your narrative.
.
Governance/Management
8. Were there any significant changes in your organization’s managerial or board leadership during
Yes
No
the past year that may have affected programming or operations?
If yes, please describe in the narrative how new leadership impacted operations, and inform MCC&HC of any changes
in staff or board personnel so that we might change our contact information.
FY16 Final Report Form
Grantee:
Page 2
Public Benefit/Accessibility/Participation
9. Describe in the narrative how your organization assesses the breadth and diversity of the audience that benefits from
its programs and services. Describe the audience specifically benefiting from the project/s funded through your History
Regrant. Detail any efforts to broaden, deepen and/or diversify participation in events/activities, including innovative
ways your organization has worked to increase participation in history programming.
10. To the best of your knowledge, report attendance and historical personnel engaged in program/s sponsored by this
grant.
a. Adult live attendance
b. Youth (under 18) live attendance
c. History professionals (historians, archivists, educators engaged
d. Indirect beneficiaries*
e. Total benefiting
This organization is not able to provide accurate figures.
Note: Indirect participation or beneficiaries refers to those served through listenership, viewership or readership via broadcast, internet or publication
of specific, grant-developed, works – and not those reached by news articles, advertising, calendar listings, etc.
Use the following guidelines:
For publications, report the number of persons using the materials or the number of copies actually distributed. Do not substitute the number of
copies produced. For broadcasting, if reliable estimates of listenership or viewership are available for the specific time of the broadcast, those
estimates may be used. If no reliable estimates are available, do not include. Do not substitute the entire population of the geographic area
that may potentially have been able to receive the broadcast. Confine your counts to featured presentations of 15 minutes or more and do not
include news reports, interviews, infomercials, etc. For internet-based participation, report the number of unique users. Do not substitute the
frequency of “hits” or times the information was accessed if the number of distinct users cannot be determined.
* In the box below, briefly describe the programs, events or activities that attracted indirect beneficiaries -- if applicable. For
example, you may simply state “1,000 people heard our full July 10 th concert broadcast live on WQXR,” or “1,000 people
received a copy of our poetry anthology,” or “2,000 people viewed our cable television program on three artists from the
county.”
Description of Event that Attracted Indirect Beneficiaries:
FY16 Final Report Form
Grantee:
Page 3
History Education
11. Special Projects expenditures attributable to pro-active history education activities.
Please describe in your narrative all educational aspects of your History Regrant-funded projects.
12. Anecdotal: Describe in your narrative at least one brief but compelling anecdote of how an individual (visitor,
student, volunteer, board member, etc.) benefited in a meaningful way from your FY16Special Projects History Regrant
activities. If you have a few good stories, feel free to share as many as you wish.
Photographs: Please submit one or two non-returnable publishable photographs of FY16 History Regrant-funded activities
(prints, slides, on CD or disk – may be emailed). Please include a description and the appropriate releases/permission to
reproduce without limitation by MCCH&C and its program partners. Images should demonstrate the public benefit or value
provided by the grant-funded activities.
I have enclosed
prints
slides
CD
disk
will forward via email to tfagan@mercercounty.org.
Narrative: Remember to attach a Narrative of no more than three pages that addresses Questions 1 – 11 (plus the
anecdotal story) as applicable, and summarizes your organization’s accomplishments in carrying out its grantfunded activities.
Support Materials: If the grant funded development of a specific product, such as a brochure, film or oral history
document, a copy or sample footage** should accompany the final report. Other organizations do not need to attach support
materials to their final reports.
Certification: We certify that the information contained in this report is true and correct, and that all expenditures were
incurred solely for the purpose of this grant. Two different signatures required: one must be of a board officer or organization
official.
Please sign in blue ink.
Executive Director or other Program Official (please print)
Signature
Date
Board President or Treasurer (please print)
Signature
Date
*** NOTE REGARDING DEADLINE FOR FINAL REPORT FY16: Per the memo accompanying this Final
Report form, please note the following.
If you plan to apply for the next round of History Regrants, your Final Report must be submitted by
end-of-day June 30, 2016.
The last 25% of your History Regrant will be sent out when your Final Report is received and
approved.
** If a media, printed, recorded, etc. History Regrant-funded project is not completed prior to the submission of this report,
Grantees should submit a portion/sample/excerpt of the project with this form; but MUST submit a finished version of the
project by September 26, 2016.
FY16 Final Report Form
Grantee:
Page 4
FINANCIAL
Category of Expenditure
Cost Budgeted in
Original Application
Grant Funds
Matching
Funds
Encumbered - Expended
Grant Funds
Matching
Transportation
Food, lodging
Photocopying, photography
Purchase, rental of equipment
Salaries, fringe benefits
Honoraria
Professional services, fees
Typesetting, printing
Postage, telephone
Materials and supplies
Typing, transcribing
Insurance, accounting service
Personal maintenance
Operating support
Other (specify)
TOTALS
I/We certify that the foregoing budgetary information is true and correct, and that all expenditures were incurred solely for the purpose
of the above grant
Grantee (authorized signature)
Title
Date
Chief financial officer
Title
Date
FY16 Final Report Form
Grantee:
Page 5
Activities Chart
Please list your organization’s public events, projects/programs that are directly funded by the FY16 MCC&HC History
Regrant. Count each performance/project as one event. Do not include board meetings or other non-public activities.
Dates
Name of Project/Activity
Total Attendance