GMES Partner Award Submission Form Your Grant Report should not exceed four (4) pages. Please submit this form as part of your report. Organization Info Organization Name Organization Mailing Address Address 1 Address 2 City State/Province Zip/Postal Code Country Contact Person Information * First Name Last Name Contact Person Telephone * Country (###) ### #### Contact Person Email * Date Grant Received MM DD YYYY Reporting Period Covered Q1 2024 Q2 2024 Q3 2024 Q4 2024 Q1 2025 Q2 2025 Q3 2025 Q4 2025 Program 1 Info Program 1 Name * Program 1 Amt Awarded * $ Program 1 Unspent Grant Award $ Program 1 Constituency Served? * Program 1 How Many People Served? * Program 2 Info Program 2 Name Program 2 Amt Awarded $ Program 2 What Constituency Served? Program 2 How Many People Served? Program 3 Info Program 3 Name Program 3 Amt Awarded $ Program 3 What Constituency Served? Program 3 How Many People Served? Additional Program Info Additional Program Names Additional Amt Awarded $ Additional What Constituency Served? Additional Program Finance Info Original Program Budget : Amount Raised * $ Amount Raised Less than Goal? If amount raised was less than goal, explain how you revised the program. Unspent balance of grant, if any: $ Unspent Balance Explanation If entire grant was not spent, explain plans and timeframe for spending the balance. Additional Program Certification I certify that this grant was used solely for the purposes designated. Certification Name * Certification Title * Certification Date * MM DD YYYY Thank you for your submission!
