Grant Reporting

General Instructions

Unless otherwise indicated, the information reported below should reflect only the program/event supported by the specific grant funds.

Save & Continue

The "Save & Continue Later" function can be found at the bottom of this report form. If selected, a pop-up notice will provide a unique URL which will allow you to access the form at a later time. You will also be presented the option to send the link via email. Please note before using this feature: Move United cannot access partially completed forms or the URLs associated with the forms. Not all browsers work with this feature (i.e. Chrome). We recommend that you test the feature before completing the full form. Another recommendation is to back up your form to a Word Document before submitting.

Chapter Information

Chapter Name*

Primary Contact Name*

First Last

Primary Contact Phone*

Primary Contact Email*

Is the Program Coordinator different from the above?

Program Coordinator Name

First Last

Program Coordinator Phone

Program Coordinator Email

Program Information

Grant Type*

Please select which type of funding you were awarded.

Military
Spinal Cord Injury/Neilsen
Training/Education
Youth Programming
Other

Program Name*

Program Location*

City State / Province / Region ZIP / Postal Code

Program Start Date

Program End Date

Select all sports offered during this program*

Other Sports Offered

What type of program is this?*

Practice (ongoing, weekly or monthly programming)
Camp (2 or more consecutive days of programs)
Clinic (1 session/day of programming)
Competition
Other (please describe)

Please describe:*

Program Participant Information

Please provide participant numbers for the program for which you were awarded a grant. Do not duplicate any participants in the numbers reported below. Leave any non-applicable populations blank or type "0"

Volunteers

Paid Staff/Instructors

Family Members

Participants with Spinal Cord Injuries

Military/Veterans Injured Post-2001

Military/Veterans Injured Pre-2001

Military/Veterans Support Staff

Low Income Youth (ages 4-15)

Low Income Youth/Young Adults (ages 16-29)

Other Youth with Disabilities (Ages 24 & Under)

Other Participants with Disabilities

Does not include instructors, volunteers, etc. who have already been counted.

Measurable Outcomes

Total Number of Program Days*

Do not include travel days, only include those where there was sports participation. Count each day adaptive sports were offered. (e.g. If golf was offered once a week for 6 weeks, the Program Days should be 6)

Total Number of Program Hours*

Only include hours of direct sports participation (e.g. if a 5 day program offered 2 hrs of adaptive sports programming a day, the number of Program Hours provided would be 10). Please do not multiply this number by the number of participants.

Total number of participant visits*

Number of individuals served each day added together (e.g. Day 1 had 3 participants, day 2 had 2 participants and day 3 had 4 participants. Your number of visits is 9)

Total number of certifications achieved

Number of individuals who achieved a certification as a result of the funding being reported on.

Certifications Achieved

List all certifications achieved. Click "+" to add an entry.

Attendee Name	Certification	Level

Program Implementations and Outcomes

Program Outreach*

Describe how you performed outreach to target population participants for this program. Include how you tried to identify NEW participants who were part of the target population.

What VA and/or Military Medical facilities had patients attend your event/program?

What (if any) new opportunities were provided due to this grant?*

Describe specifically how the grant funds positively impacted your program immediately.*

Describe specifically how the grant funds may positively impact your program moving forward (within the next 12 months).*

e.g. We expect that approximately 10 low income youth with disabilities will be able to use equipment purchased with the grant funds; We plan to include veterans in 3 more events in the next 12 months; etc.

Program Success Story*

Provide success stories with specific positive outcomes related to improvements in physical health, mental health, and employment. (e.g. As a result of this program, John has joined a gym and has set a goal to lose 50lbs; Derrick has gained confidence and skill to kayak on his own with his family; etc.)

Participant Quotes*

Please provide a quote(s) from a participant/volunteer that highlights the success of your program.

Provide a summary of your results from program evaluation process.

Chapters should have a programmatic evaluation system in place to evaluate the effectiveness of their direct programming.

Expense Report

Please list all program specific expenses below. Mark "0" in fields that do not apply.

Air Travel*

Event/Registration Fees*

i.e. Standard program/event fees offset by grant.

Event Supplies*

Facility Costs & Lift Tickets*

i.e. Space rental, trail passes, lift tickets

Ground Transportation*

i.e. Auto rental, gas/mileage, train/rail pass

Instructor, Trainer, Clinician/Coaches Fees*

Standard rate of pay for direct program hours

Lodging*

Up to any standard industry intermediate hotel. Luxury brands and upgrades excluded.

Meals & Per Diem*

Within reason (i.e. no alcohol, tips not to exceed 20%)

Program Advertising*

Sports Equipment*

Other (Please list)

Justifications

Use this field to provide justification for any fields which may not be supported by receipts/proof of purchase. (e.g. Instructors Fees = # Instructors x Rate of Pay x Direct Programming Hours)

Total*

Total expenses applied to the grant, not to exceed the grant amount awarded.

Supplemental Documentation (check your grant agreement for which files are required)

Note: Maximum combined file upload size is 25MB. Should your combined file size exceed this amount, please send each file in a seperate e-mail to Najeeb Siddiqui (not to exceed 10MB per e-mail), nsiddiqui@moveunitedsport.org

Invoice

Provide invoice from your organization to Move United for final grant amount requested.

Drop files here or

Participant Report

Drop files here or

Program Expense Receipts

Many funding sources, require us to track all expenses with receipts (even if we do not ask for them maintain on file for audit). Must show –Breakdown of fees; Dates; In case of flights, passenger names (don’t just submit the final payment page) Unacceptable: Ex. 1 – Credit card slip – does not show what was actually purchased Ex. 2 – Gas receipt –does not include price/gallon, or even say really what was purchased Acceptable: Ex. 1 – Detailed invoice. Clearly lists description and fees. One note, there is a difference between a packing slip and an invoice – make sure whatever you submit has the cost breakdown/proof of payment Ex. 2 – Line item – all items detailed so that we can easily scan to make sure items are allowable expenses

Drop files here or

Photos

Drop files here or

Media

Drop files here or

Upon hitting submit, you will receive an e-mail confirming your submission.

The email is proof of your grant submission. Please contact nsiddiqui@moveunitedsport.org if you do not receive.

Comments

This field is for validation purposes and should be left unchanged.

#AdaptatHome COVID-19 Updates

General Instructions

Save & Continue

Chapter Information

Program Information

Program Participant Information

Measurable Outcomes

Program Implementations and Outcomes

Expense Report

Supplemental Documentation (check your grant agreement for which files are required)

Upon hitting submit, you will receive an e-mail confirming your submission.