Nursing Excellence Fund Grant Award Report

A Nursing Excellence Fund grant report must be submitted by the legally accountable party for the funds, for example, CEO, President, Executive Director.

Grantee organization name.*

Project name.*

Grant amount received.*

Please upload a report that includes at a minimum the following information:

A. Grantee name;
B. Total funding requested and received for the grant period to include start and end dates;
C. Project name and goal;
D. Summary of grant/project activities;
E. List objectives and accomplishments/outcomes for the funded period;
F. Key successes and challenges during the report period;
G. Budget summary to include breakdown of actual and projected expenses and any unused funds; and
H. Any other items requested of the grantee by the board or agency staff.

Upload Report*

I affirm the following:

We have attached all documents as required and attest that these are true and reliable submissions regarding our intent to applyfor funding from the Nursing Excellence Fund.
We agree to submit a minimum of one report at the end of the award year at a regularly scheduled Board of Nursing meeting. We also agree to submit any interim reports as requested by the Board.

I am the legally accountable party for the Nursing Excellence funds.
By digitally signing below, I attest that all the information provided in this webform is true, accurate, and complete to the best of my knowledge. I understand that any false or misleading information may result in consequences as determined by applicable laws and regulations. I acknowledge that the digital signature is my legally binding electronic signature for this document.

Submitted by:*

First NameLast Name

Position/Title*

Phone Number*

Please enter a valid phone number.

Email Address*

example@example.com

Signature*