Grant Purpose Due Diligence Confirmation

Organization*

Name of Person Completing This Form*

Role at Organization*

Email*

This email will be used for follow-up if needed.

Grant Amount (See Form enclosed with your check)*

Grant Number – (See Form enclosed with your check)*

Provide Explanation of how funds were used and why:

Additional Explanation Documentation (If Applicable)

Max. file size: 32 MB.

If organization is unable to use funds as instructed, please provide an explanation describing how the funds were expended and why.

Signature*

I attest that the grant funds described above and submitted from the Community Foundation of Southern Indiana to our organization were expended as instructed or an alternative explanation was provided.

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Grant Purpose Due Diligence Confirmation

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