Dear Recipient: Congratulations! Your organization was selected to receive a grant from the South Central Indiana REMC Community Fund — branded nationally as Operation RoundUp. Participating SCI REMC members’ bills are rounded up each month to the nearest dollar, and the additional change is considered a charitable donation to the SCI REMC Community Fund. This program allows SCI REMC members the opportunity to make a powerful impact on their communities for just pennies a month! SCI REMC members are not required to participate, so it is vital to the continued success of the SCI REMC Community Fund to encourage members by promoting your success and managing statistical information. To do this, we need a completed final report from each organization receiving funds.Items to include in your report: Final report form Pictures and/or video of the project/program in action “Before” pictures and/or video (if available) Summary of the progress/results using the goals listed in the original grant application Description of any significant challenges experienced related to the funded grant project/program Final reports should be turned in within 30 days of receiving the grant. (They are due no later than 6 months after grant funds are received.) Failure to remit a final report will result in future applications being removed from consideration. Thank you for your interest in SCI REMC’s Community Fund. Please contact us if there are any questions or concerns (800) 264-7362, or email us. Sincerely, SCI REMC Operation RoundUp TrusteeLegal Name of Organization:(Required) Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Website Contact Person Name(Required) First Last Work Phone(Required)Cell PhoneFaxEmail(Required) Project Name(Required) Amount Granted(Required) Start Date of Program/Project (mm/dd/yyyy)(Required) Month Day Year End Date (mm/dd/yyyy)(Required) Month Day Year How many individuals were served by the project/program in the following Indiana counties?ClayBrownJohnsonMorganMonroeOwenPutnamOtherPlease include the following supporting documents with this form: Pictures and/or video of the project/program in action “Before” pictures and/or video (if available) Summary of the progress/results using the goals listed in the original grant application Description of any significant challenges experienced related to the funded grant project/program Upload supporting documents(Required) Drop files here or Select files Max. file size: 100 MB. Consent(Required)I represent that I am authorized by the named organization to submit this final report on its behalf and to make the assertions in this certification and to bind the organization accordingly. I understand that the SCI REMC Community Fund has the right to fully audit the use of this donation at any time. I also understand that SCI REMC Community Fund and SCI REMC Cooperative may use this, if approved, for publicity and promotional purposes. I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Electronic Signature (Full Name)(Required) PhoneThis field is for validation purposes and should be left unchanged.
