Youth Resources of Southwestern Indiana TEENPOWER Grant Final Paperwork Submission

Reimbursement Request

School: *

Adult advisor: *

First

Last

Make check payable to: *

Address to mail the check: *

Address Line 1

Address Line 2

City

State

Zip Code

We are requesting $_____ be reimbursed. *

Advisor cell phone: *

Advisor work phone: *

Receipt Upload

Please scan and upload all receipts that are to be reimbursed with TEENPOWER Grant funding. We cannot reimburse tax and we cannot reimburse funding without receipts. Please SCAN and merge all receipts into one PDF to avoid exceeding the maximum upload size. We like www.ilovepdf.com for merging and compressing PDFs. Please SCAN receipts - do not upload photos.

Receipt Upload *

Click or drag files to this area to upload. You can upload up to 10 files.

Project Evaluation Information & Questions

Listed below are the evaluation questions and items that you need to complete and submit no more than 2 weeks after your project is fully completed. It is very important that you respond to each question.

Please write a paragraph describing the primary accomplishments for your project. *

Specifically state how youth were involved in your project. *

Based on the group’s goals and/or objectives, was the project a success? *

Photo/Video Upload

There is a maximum upload size of 256 mb per file. If you run into issues uploading your photos and videos, please create a Google Drive folder or Google Photos album and share with bailey@youth-resources.org.

Please provide photos that show the various stages of your project. *

Click or drag files to this area to upload. You can upload up to 20 files.

In order for Youth Resources to receive funding to support future TEENPOWER grants, please provide the following:

YOUTH PARTICIPANTS

Total number of youth volunteers *

Average hours of service per youth *

Participants by Gender

Female
Male
Other gender

Check all that apply.

Mentally or physically disabled (#) *

Economically disadvantaged (#) *

DEMOGRAPHIC INFO (of youth volunteers)

White (#) *

African American (#) *

Asian (#) *

Hispanic (#) *

Other (#) *

COUNTY OF RESIDENCE (of youth volunteers)

Gibson County (#) *

Posey County (#) *

Spencer County (#) *

Vanderburgh County (#) *

Warrick County (#) *

Henderson County (#) *

Other (#) *

OTHERS INVOLVED

Total number of adult volunteers *

Average hours of service per adult *

How many people were impacted by your project? (Please estimate the best that you can.) *

TEENPOWER Grant Final Paperwork Submission

Thank you for your hard work on your TEENPOWER grant project!