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									Missouri 4-H Foundation
Kemper and Pioneer Community Service Grant Report Form
Date:

Grant No.:                      Start Date:           Completion Date:

County:             Name of group(s) making report:

Project Title:

Name of contact person responsible for project:

  Brief Description.




  Who benefited?


  Number of community members served:

  How were 4-H youth involved?




  No. Volunteers:               4-H Club members            4-H Adult Volunteers

                                Community youth             Community Adults

  How did youth take the lead in planning, conducting and evaluating the project?




  Please list all publicity (newspapers, online, etc.). What public relations methods were used?

        sign at project site         press release       media interviews

        other (please specify    )

  How did you recognize the Missouri 4-H Foundation, Kemper/Pioneer? (project signs, etc.)



Within 30 days of project completion, email the Community Service Grant Report to
Kristen Heitkamp at the Missouri 4-H Foundation, 4hfoundation@missouri.edu.
Please email or mail photos, news articles or printed materials.




                                                                                      REV 11/18/10
Community Service Grant funds expenses:
Item/ Paid to                                                                     Cost




 TOTAL is automatic: right-click and choose “Update Field”                        $ 0.00

Matching funds or in-kind match (figure adult volunteer labor at $18.70/hr; youth volunteer
labor at $7.25/hr.)

Match funds/ Labor/ In-Kind Donation




 TOTAL is automatic: right-click and choose “Update Field”                        $ 0.00




                                                                                  REV 11/18/10

								
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