Post Grant Report Form

Please fill out and submit the Post Grant Report Form below. If you'd prefer, you can open the Post Grant Report Form as a PDF to fill out and fax, mail, or e-mail.

Also, please fax, mail, or e-mail the following items to Jill Kitchin at the Teleflex Foundation:

• A recent financial audit
• A brief financial statement describing the expenditure of the grant funds

Jill Kitchin

Teleflex Foundation

155 S. Limerick Road

Limerick, PA 19468

Fax: (610) 948-2858

Phone: (610) 948-2853

Email Teleflex Foundation

Date:
Organization:
Contact Person Name and Title:
Contact E-mail Address:
Contact Phone Number:
Project Title:
Report Period:
ALL QUESTIONS MAY NOT APPLY TO YOUR GRANT
How was the Teleflex Foundation Grant used?
List the goals and objectives of the grant and tell how they were met during this reporting period.
What impact did the grant have in the community and/or the population served? How many Teleflex employees were served?
What factors contributed to your success?
What limited your program's progress?
Describe any unanticipated outcomes, benefits or challenges encountered with this project, including current status on meeting any specific fundraising goals or challenge grants.
Who else funded the project, and at what level?
Do you have any additional comments?
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