Georgia Firefighters Burn Foundation, Inc.
Brant Chesney Memorial Fire and Burn Prevention Grant
Program Evaluation

 

Thank you for completing this program evaluation report. It will be used to assess future grant applications from Georgia fire departments. If this required project completion report is not submitted to the GFBF within sixty (60) of the project completion date and/or by December 31, 2007, the Department may not be eligible for future funding through this grant program. Thank you for your cooperation!

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  1. Fire Department:

 

  1. Total amount of grant received from GFBF:

 

  1. Source of other funds used to complete the project (e.g. other grants, donations, etc.):

 

 

  1. Briefly indicate how you spent your grant funds for this project:

 

  1. Estimate the total number of individuals your project has reached thus far since its implementation after receiving the grant:

 

 

  1. Estimate the total number of individuals your project will reach within the next year:

 

 

  1. List any organizations/agencies that partnered with your department for this project:

 

 

  1. How can the GFBF improve this grant program for next year?

  

 

  1. Name and contact information of individual completing this report (name/address/phone/fax/email):

 

 

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Please attach all supporting materials including any receipts, videos, media clips and photographs and return this report by mail or fax no later than December 31, 2007 to:

 

Georgia Firefighters Burn Foundation, Inc.
ATTN: Brant Chesney Memorial Grant Program
2575 Chantilly Drive
Atlanta, Georgia 30324
Phone: (404) 320-6223
Fax: (404) 320-6190