Contribution Follow Up Questionnaire

Organization:
Request Summary:
Date of Contribution:
Date of Follow Up Discussion:
Individual(s) Interviewed (including phone number and email address):
Date(s) of the expenditure(s) and amount(s):
Were the funds used for the requested project?:
What was the total amount expended on the project?:
What was the budget?:
What is the actual breakdown of the total cost for the project itself?:
What did the participants have to pay?:
Do you have age, demographic and economic statistics on the participants?:
Is there a record of the actual number of youth impacted?:
Is there a list of names and ages we can review?:
Who else contributed to this project and How much did each contribute?:
Were you able to leverage the funds for a greater impact?:
Will you make a similar request to the Rotary 21 Youth Services Committee next year?: *not a guarantee