Funding Reconciliation Form

* Indicates required field

Name of Organization *

Name of Funded Project *

Contact's Phone *

Funding Date *

Total Amount Funded *

PLEASE EMAIL THE FOLLOWING TO THE ADDRESS BELOW:
1. A narrative describing what goals and outcomes were achieved through this project and specifically how residents and communities within Plumas County benefited.

2. A two column spreadsheet outlining the project's original budget projections vs. actual expenditures. Copies of receipts must be attached.

Please complete this form once all project funds have been expended or not later than one year from the date of funding.

For assistance with this form or to submit required files, please email commongoodplumas@gmail.org.

By submitting this form, you certify that the information provided is accurate and you are the authorized representative for the agency named in this form.

Name *

First

Last

Title *

Submit

The Common Good Community Foundation
364 Johnsville Road
Blairsden, CA 96103
Email: commongoodplumas@gmail.com
Phone: (530) 836 - 0136