Impact Report Information *Actual People Served *Actual Gender *Actual Age Group ages Children (0-12) Youth (13-18) Adults (19-24) Adults (25-55) Mature (56+) *Actual Ethnic background African American or Black Asian and Pacific American Islander Hispanic or Latino Multi-ethnic American Indian or Alaskan Native White (Yes/No) Actual Served by Gender Unknown/unreported Actual Served by Age Group Adults (18-34) Adults (35-55) Mature (56+) *Financial Accountability Summary (File Upload)File Upload; 10485760 byte limit *Goals and Objectives *Measurable Results *Communications Summary *Promotional / Media Materials (File Upload)File Upload; 10485760 byte limit Enter the number of people served as a result of this grant. Enter whole numbers only, total must equal the number entered in "Actual People Served" field above. Enter whole numbers only, total must equal the number entered in "Actual People Served" field above. Enter whole numbers only, total must equal the number entered in "Actual People Served" field above. Did the program serve U.S. military veterans? Please provide the total number of veterans served as a result of this grant. This does not include military family members, only people who have served in the military themselves. Please provide the number of veterans served in each age group as a result of this grant. This does not include military family members, only people who have served in the military themselves. Attach a financial statement showing budgeted costs versus actual costs, revenue and expenses for the funded program, and provide details for each budgeted line item. Provide explanations for deviations in actual and/or proposed expenses from original approved budget. List the goals and objectives for this program, as well as the course of action taken to meet those goals and objectives. List any measurable results from this program (if possible, please include the number of persons impacted by the program and any other quantifiable benefits). Describe how this grant was promoted in the organization's local community and how the organization communicated final results to the general public. Attach any promotional or media materials related to this grant. 1
*Sustainability Summary *Lessons Learned Describe plans for sustaining this program in the future. What funding will be required to ensure continuance of the program and how will this funding be acquired? Describe any challenges that occurred for this program and how they were resolved. What knowledge was gained for the organization as a result of this program? Actual Metrics If a metric below does not apply to the funded program, enter "N/A" for text fields or "0" for number fields. Service Type (Multi-Select List) Home Delivered Meals Congregate Meals Grocery or Food Distribution Benefits Enrollment Nutrition Education Cooking Skills Education Capacity Building Actual number of people served Children (0-17) Adults (18-59) Seniors (60+) Actual Congregate Meals Actual Home Delivered Meals Please specify which service(s) the program provided to the organization's target population. To choose more than one service type, hold down Ctrl and click (Cmd and click for Apple computers). Please enter the number of people in each age range that were served as a result of this grant. Please note: the age ranges represented here are not the same as the age ranges in the Demographics section. Please provide the number of congregate meals provided as a result of this grant. Please provide the number of home delivered meals the organization provided as a result of this grant. Actual Federal Meal Reimbursements Child & Adult Care Food Program (CACFP) Please provide the number of meals that were reimbursed through the organization's participation in any of the federal School Breakfast Program (SBP) programs listed below. Summer Food Service Program (SFSP) Actual Site/Location Types Schools Churches YMCAs/YWCAs Boys & Girls Clubs Other Locations Actual Pounds of Food Distributed Actual Backpacks Distributed Actual Average meals per pack Actual Average Pounds per pack Please enter the number of each type of site the organization supported as a result of this grant. This does not include home delivered meals. Please provide the total pounds of food distributed as a result of this grant. How many backpacks were distributed as a Please provide the average number of meals contained in each take-home food pack. Please provide the average number of pounds contained in each take-home food pack. 2
Actual Number of Sites Actual Households Informed Actual Households Assisted with Application Actual Households Enrolled Supplemental Nutrition Assistance Program (SNAP) Women, Infants, and Children (WIC) Actual People Instructed Up to 6 hours of instruction More than 6 hours of instruction Actual Vehicles (Capacity Building) Refrigerated Trucks Other vehicles Actual Vehicle Details (Paragraph)(500 character maximum) Actual Equipment Details (Paragraph)(500 character maximum) Actual number of people provided career/support services Actual Job Skills Program Length Actual Job Skills Program Duration Job Training (No input required) Actual Average Job Placement Rate Actual Adult Basic Education enrollment Please provide the number of sites served as a result of this grant. Please provide the number of households given information on federal benefits as a result of this grant. Please provide the number of households assisted with application for federal benefits as a result of this grant. If no households were assisted, enter 0. Please provide the number of households enrolled in federal benefits programs as a result of this grant. If no households were enrolled through this program, enter 0. Please provide the number of people given instruction as as result of this grant. Please enter the number of vehicles the organization purchased as a result of this funding request. If the organization did not purchase any vehicles, enter 0. Please provide details on the types of vehicles the organization purchased as a result of this grant. If the organization did not purchase vehicles, enter N/A. Please provide the details of equipment (type and number of units) that the organization purchases with the use of this funding request. If the organization did not purchase equipment, enter N/A. How many people received career or support services as a An individual who may receive more than one service should only be counted once for this question. How long (in days) was the proposed program? What was the average number of hours in jobs skills training programs that participants received as a Please provide the total number of individuals served through each of the following services. If an individual receives more than one type of service, count them once for each service type they will receive. What was the average placement rate of those that completed training as a How many people enrolled in adult basic education services as a 3
enrollment Actual Soft Skills Training Enrollment Actual Adult Basic Education completion completion Actual Soft Skills Training Completion Actual Job Training Credentials Job Placement metrics (No input required) Actual Part-Time Positions Actual Full-Time Positions Actual Internships/Apprenticeships Actual Self-Employed/Entrepreneur Actual Temporary Employment Actual Wrap-Around Services (Checkbox List) WIC SNAP Childcare Mental Health Services How many people enrolled in occupational or vocational How many people enrolled in soft skills training services as a How many people completed adult basic education programs as a How many people completed occupational or vocational How many people completed soft skills training services as a How many people received credentials/certifications as a result of this grant? many people were placed in part-time positions? many people does were placed in full-time positions? many people were placed as interns or apprentices? Of those who completed training as a result of this funding request, how many people became self-employed or entrepreneurs? many people does were placed in temporary employment positions? Please check all additional services that were provided to individuals receiving job training services as a result of this grant. 4
Financial Literacy Transportation Housing Assistance Emergency Food Supply Earned Income Tax Credit Actual Career Opportunity - (Yes/No) -Specific Metrics (No input required) Actual Average Job Placement Rate - Actual Adult Basic Education enrollment - enrollment - Actual Soft Skills Training enrollment - Actual Adult Basic Education completion - completion - Actual Soft Skills Training completion - Actual Job Training Credentials - Actual Part-Time Positions - Did the program provide U.S. military veterans with job skills training and/or placement assistance? Please provide the total number of veterans served through each of the following services. If a veteran receives more than one type of service, count them once for each service type they will receive. What was the average placement rate for veterans that completed training as a How many veterans enrolled in adult basic education programs as a How many veterans enrolled in occupational or vocational How many veterans enrolled in soft skills training services as a How many veterans completed adult basic education programs as a How many veterans completed occupational or vocational How many veterans completed soft skills training services as a How many veterans received credentials/certifications as a many veterans were placed in part-time positions? 5
Actual Full-Time Positions - Actual Internships/Apprenticeships - Actual Self-Employed/Entrepreneur - Actual Temporary Employment - Actual Wrap-Around Services - (Checkbox List) WIC SNAP Childcare Mental Health Services Financial Literacy Transportation Housing Assistance Emergency Food Supply Earned Income Tax Credit many veterans were placed in full-time positions? many veterans were placed as interns or apprentices? many veterans became self-employed or entrepreneurs? many veterans were placed in temporary employment positions? Please check all additional services that were provided to veterans receiving job training services as a result of this grant. 6