Community Partners Impact Report - Due SEPTEMBER 1, 2023

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REVIEW PERIOD

The TIME FRAME covered for the September Community Partners Impact Report is:

July 1, 2022 to June 30, 2023, a full TWELVE MONTHS, for Budget and Outcome Measures, and

January 1 to June 30, 2023, a SIX MONTH PERIOD, for Demographics.

AGENCY INFORMATION

Agency Name

First and Last Name Executive Director/CEO:

First and Last Name Person Completing:

Title Person Completing:

Email Address Person Completing:

Phone Number Person Completing:

PROGRAM INFORMATION

Program Name:

First and Last Name Program Director:

Please select the area of impact of your program:

EDUCATION. Children and youth are equipped to learn at every grade and are prepared for success after high school graduation.HEALTH. Individuals and families have access to healthcare, improve their health, or maintain their health.FINANCIAL STABILITY. Individuals and families improve their socio-economic status.

What challenges and/or successes did you experience between Jan 1 and June 30, and how did they affect the implementation or success of this program?

(250 words or less)

Have there been other significant changes within the program between Jan 1 and June 30?

(250 words or less)

PROGRAM BUDGET

Total amount of United Way Grant awarded for the 12 month review period, July 1, 2022 to June 30, 2023:

Total amount of United Way Grant expended in the 12 month review period:

Percent of total award spent in the 12 month review period:

If you did not expend the entire amount of the grant monies received, please explain (or write "entire amount spent"):

(50 words or less)

Total Program Budget for the 12 month review period:

Program Expenditures for the 12 month review period:

Percent of total budget spent in the 12 month review period:

Program Outcomes/Impact in the PAST FUNDING YEAR

Please share the results of your work covering the entire 12 months of the funding year, that is July 1, 2022 to June 30, 2023. The outcomes reported on below should match the "anticipated" outcomes that you listed on your application for funding in March of 2022.

	Outcome Desired	Data/Tools Used to Track Progress	# of Clients Receiving Service	# Clients Achieving Desired Outcome	% Achieving Desired Outcome	% Targeted
Outcome #1
Outcome #2
Outcome #3
Outcome #4

Comments on Outcome Results from the PAST FUNDING YEAR:

OPTIONAL (50 words or less)

DEMOGRAPHIC REPORTING SIX MONTHS

Demographic Reporting for January 1, 2023 through June 30, 2023, a SIX MONTH PERIOD.

Definition:

A client served is a person who received services from your program.
In the case of a program which has membership, count only those who are officially members of the program.
Count unduplicated clients served at your Allen County location, regardless of the clients county of residence.
Count only the clients served through the Program funded by your United Way grant.
If your program/service is offered inside the schools, you may use the zip code of the school.
PLEASE NOTE: The "totals" in each category should be the same from category to category.

Clients Served by Area of Residence

Please input the number of unduplicated clients served from each location listed below. Please count only clients served in Allen County through the funded program. If the clients residence is outside of Allen County and they were served in Allen County, please list their zip code as "Unknown". If your program is offered inside the schools, use the zip code of the school where the service was provided.

Lima/Bath - 45801

Lima - 45802

Lima/Bath - 45804

Lima/Shawnee - 45805

Lima/Shawnee - 45806

Lima/Elida - 45807

Beaverdam - 45808

Gomer - 45809

Bluffton - 45817

Cairo - 45820

Delphos - 45833

Harrod - 45850

Lafayette - 45854

Spencerville - 45887

Unknown/Other

Total Number of Clients Served by Residence (this number should be the same for all categories):

Clients Served by Age

Please input the number of unduplicated clients served from each age category listed below. Please count only clients served in Allen County through the funded program.

0 to 5 years

6 to 18 years

19 to 24 years

25 to 62 years

62 and above

Age Unknown

Total Number of Clients Served by Age Category (this number should be the same for all categories):

Clients Served by Gender

Please input the number of unduplicated clients served from each gender category listed below. Please count only clients served in Allen County through the funded program.

Male

Female

Gender - Other

Gender Unknown:

Total Number of Clients Served by Gender Category (this number should be the same for all categories):

Clients Served with Disabilities

Please input the number of unduplicated clients served from each disability category listed below. Please count only clients served in Allen County through the funded program.

Male with Disability

Female with Disability

Gender-Other with Disability

No Disability/Unknown

Total Number of Clients Served by Disability Category (this number should be the same for all categories):

Clients Served by Race/Ethnicity

Please input the number of unduplicated clients served from each racial/ethnic category listed below. Please count only clients served in Allen County through the funded program.

African American

American Indian or Alaska Native

Asian

Caucasian

Hispanic or Latino

Multi-Racial

Pacific Islander

Ethnicity/Race Unknown/Other

Total Number of Clients Served by Racial/Ethnic Category (this number should be the same for all categories):

Clients Served by Income Level

Please input the number of unduplicated clients served from each income level category listed below. Please count only clients served in Allen County through the funded program.

Above the Federal Poverty Level

Below the Federal Poverty Level

Income Level Unknown

Total Number of Clients Served by Income Level Category (this number should be the same for all categories):

Additional Explanation

Feel free to record any additional explanations you feel would be helpful:

OPTIONAL (50 words or less)

AUTHORIZATION

I verify that I have reviewed the information provided and it is accurate and correct to the best of my knowledge.

Agency Executive Director/CEO - First and Last Name:

Agency Executive Director Email Address:

Date Completed:

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