Livingston Township
Municipal Alliance Committee
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DATE
____________________
FUNDS USED TO DATE $_______________
NAME OF PROGRAM OR
ACTIVITY_____________________________________________
DATE OR DATES OF ACTIVITY
(ATTACH A CALENDAR IF NEEDED) _________________
NAME OF PERSON(S)
RESPONSIBLE FOR COORDINATION OF ACTIVITY AND
THEIR TITLE
________________________________________________________________
BRIEF DESCRIPTION OF
ACTIVITY (use an additional page if necessary)________________
____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
IS PROGRAM COMPLETE AS OF
THIS DATE? _____YES _____NO, if no projected date of completion
__________________
NUMBER
OF VOLUNTEERS INVOLVED
________
NUMBER
OF COMMUNITY PEOPLE ATTENDING _________CONTACTED___________
NUMBER
OF YOUTHS PARTICIPATING ________ NUMBER OF ADULTS _________
AGES OF YOUTHS
PARTICIPATING _______________
WAS THIS PROGRAM REPORTED
BY THE MEDIA?____ (IF YES ATTACH COPY)
IS THIS PROGRAM CAPABLE
OF BEING SELF SUPPORTING? ____YES ____NO
WOULD YOU REPEAT THIS
PROGRAM IN THE FUTURE? _____YES _____NO
IF AN EVALUATION
WAS USED, PLEASE ATTACH
LIST OTHER AGENCIES
AND/OR ORGANIZATIONS INVOLVED IN THIS ACTIVITY
__________________________________________________________________________
SHOULD
THIS ACTIVITY BE INCLUDED IN THE NEXT GRANT? ____YES ____NO
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ADDITIONAL
COMMENTS ____________________________________________________
___________________________________________________________________________