Form

Community Assistance Report

Thank you for reporting back to JLWJC as a grant recipient. Please complete the following form to report on the usage of the funding.

Name of Organization

Your Name & Title

E-mail

Phone

Amount Granted

How was the grant used?

Briefly describe the impact the grant has had and will have

Please provide any photos we can share

Check this box if you have additional photos and email them to grants@jlwjc.org

I have additional photos I will email

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