Project & Patient Assistance – Final Report | Hemophilia Alliance Foundation

Project/Patient Assistance Grant – Final Report

Grant recipients are required to submit a final report after the project’s completion. The report must follow the outline below, and must be submitted electronically by April 15 at 11:59 PDT.

FAILURE TO SUBMIT A FINAL REPORT WILL MAKE THE RECIPIENT INELIGIBLE TO RECEIVE FUNDING FOR SUBSEQUENT YEARS’ PROJECTS UNTIL THAT REPORT IS RECEIVED. IF THE RECIPIENT HAS APPLIED FOR AND BEEN AWARDED A GRANT FOR THE FOLLOWING YEAR, THE AWARD CHECK WILL BE HELD UNTIL THE FINAL REPORT IS RECEIVED.

Please note that copies of receipts and other justification of expenses are not required in this submission, however it is expected that adequate documentation would be available in the event of an audit. The Hemophilia Alliance Foundation Board reserves the right to conduct a program and financial audit of documents and finances associated with this grant.

"*" indicates required fields

Grant-Funded Year*

1. Contact information

a. Name of organization*

b. Name of contact person*

c. Phone for contact person*

d. Email for contact person*

e. Authorized Person’s signature*

2a. Name of Project*

2b. Amount of grant*

3. Objective(s) of the project.*

4. Describe how well the proposed objectives were met.*

5. Describe how the project strengthened the organization and/or its patients/consumers.*

6. Financial report: Please reproduce here the original budget, adding a column showing actual expenses.*
Example:

List*

Item

Budgeted

Actual Spent

7. Amount, if any, of funds remaining.*

Note 1: After clicking the "Submit" button below, a notification email, along with a link to a PDF of this form submission, will be sent to the email that you've entered into the "Email for contact person" field. However, the PDF can only be accessed from the same computer that was used to submit this form. This is a security measure to prevent unauthorized downloads. Therefore, if you're submitting this form on behalf of someone else and have input their email address into the "Email for contact person" field, then they'll need to email the PDF link to you so that you can access it from your computer.

Note 2: If, after submitting the form, you don't receive a notification email in your Inbox, then please check your spam folder and whitelist the email address "info@hemophiliaalliancefoundation.org".