Final Report

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Grant Final Report

Please fill out your final report below or download the final report document and email to:

TYPE OF REPORT

Community Grant Final Report School Grant Final Report

Project Name

Identify the organization or school that completed this project

Your Name

Date

Telephone #

Location of Project:

Other participating communities:

Project Summary:

Wellness Priority Area(s) Addressed:

Healthy Eating Tobacco Control Physical Activity Injury Prevention Mental Health Child and Youth Development Healthy Environments Sexual and Reproductive Health

Amount of Grant Received:

Amount of Grant Returned:

SUM OF GRANT RECEIVED

AMOUNT RETURNED

List receipts below: brief description, followed by amount:

UPLOAD COPIES OF YOUR RECEIPTS (scan and upload or email to: info@westernwellnesscoalition.com)

EVALUATION SUMMARY Check the boxes that describe the population(s) that participated in your project

Preschool School-age (Primary, Elementary, Junior High, Senior High) Youth (16-30) Indigenous Women Gender Diverse Persons with special needs Rural and/or remote community with few programs and services Participants living with chronic disease Lifestyle factors (smoking/vaping/alcohol/drugs, food security, physical activity levels, helmet use, risky driving, recreational vehicle use, etc.) other

Number of participants in you project

Number of volunteers in your project

Please summarize any participant feedback you have received:

Please summarize any leader feedback you have received:

List your partners and their contributions:

Is this partner a potential partner for future projects?

Yes No Unsure

Is this partner a potential partner for future projects?

Yes No Unsure

Is this partner a potential partner for future projects?

Yes No Unsure

Is this partner a potential partner for future projects?

Yes No Unsure

SUSTAINABILITY REPORT

PLEASE INDICATE TO WHAT EXTENT YOU AGREE OR DISAGREE WITH THE FOLLOWING STATEMENTS: The WWC Grant Guidelines are useful