TEENPOWER Grant Final Paperwork Submission

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

Please complete all the sections below in order to be reimbursed for your TEENPOWER grant project.

If you have questions while working on this form, please contact:
Bailey Daniels, Program Coordinator
812-421-0030 ext. 15
bailey@youth-resources.org

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- Step 1 of 3

Reimbursement Request

School: *

Adult advisor: *

First

Last

Make check payable to: *

Address to mail the check: *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

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

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Next

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.

Drag & Drop Files, Choose Files to Upload You can upload up to 20 files.

Next

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.

Number of female youth volunteers *

Number of male youth volunteers *

Number of other gender youth volunteers

Please include gender identities and number of youth volunteers for each.

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.) *

Submit