Grants from The 1772 Foundation: Funding Project Summary and Final Report Form

Please fill out and upload your organization's documents in order to complete the final report form.

Email Stefon Danczuk with questions: sdanczuk@preservationct.org

Organization Information

Choose one: *

Final Report
Interim Report
Extension Request

What year was the grant awarded to you?

Full name of the applicant organization (should be the same as application) *

Federal EIN number (Tax ID) PLEASE DO NOT INCLUDE HYPHEN *

Organization mailing address *

Address Line 1

Address Line 2

City

State

Zip Code

Physical address of project Site *

Address Line 1

Address Line 2

City

State

Zip Code

Contact information for report preparer:

Report Prepared by *

First

Last

Title *

Preparer's Phone Number *

Preparer's Email Address *

Alternative Email Address

Project Information

Summarize the purpose of the grant (100 words maximum): *

Choose One: *

This project has been completed
This project is ongoing

Please include the name of the person or company that was hired:

Briefly review the work performed by the above individual or firm (150 word maximum) *

Project Cost

Funds provided by The 1772 Foundation Grant *

Funds provided by other sources *

Final Total Project Cost: *

Describe any budget changes or financial adaptations required by any unforeseen situations (50 word maximum) *

Describe any other unforeseen decisions made during this project (50 word maximum) *

Please provide a brief testimony about the impact of this project funding for your organization *

Describe your organization’s next steps to further the Preservation efforts at the project site (100 word maximum) *

Photo and File Uploads

Please upload 4 project photographs as JPEG or PNG files. **If you are having trouble uploading photos and documents, please allow one file to finish uploading before uploading another.**

Front Façade of project Building *