First 5 LA Project Grantee Collection Data Q# on Form
OG
Section on Form Name on Form
Note
Data collected on Form
Data Type on Form Business Rules
1
OG1 Org & Geo Info Organizations Annual Budget (Organizational and Geographic Information)
Check one
Dropdown
2
OG2 Org & Geo Info
Type of Organization
Check one
Checkbox
3
OG3 Org & Geo Info
Supervisorial District served by this project.
Select Multiple
Checkbox
4
OG4 Org & Geo Info
Service Planning Area (SPA)
Select Multiple
Calculation
This section will only be asked of new grantees. We'd like to run this by organization as well as by contract #
Entered by Grantee
Entered by Grantee
Can select 1 to 5
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox 5
OG5 Org & Geo Info
Percent of Money to Direct Services: Services delivered to an individual or group of children 0-5, their parents, other family members and/or individual service providers.
5
OG5 Org & Geo Info
Percent of Money to Organizational Support: Training and support of grantees and contractors to improve their capacity to participate and deliver services.
Estimate what PERCENTAGE of your First 5 LA funding for this project went to Direct Services, Organizational Support, and/or Systems Change. If you did not provide one or more of these services, leave 0 in the answer field.
Page 1 of 10
Source
Entered by Grantee
whole number
IF the grantee does not fill out the related report, the percent is zero.
number
IF the grantee does not fill out the related report, the percent is zero.
The percent for the three categories must total 100.
Entered by Grantee
Entered by Grantee
funding for this project went to Direct Services, Organizational Support, and/or Systems Change. If you did not provide one or more of First 5 LA these services, leave 0 in the answer field. Project Grantee Collection Data
Q# on Form
OG
Section on Form Name on Form
5
OG5 Org & Geo Info
Percent of Money to Systems Change: Efforts to support improvement in the systems, policies, and infrastructure that serve young children and their families.
1
DS1 Direct Services
Direct Services funding used for services in each Supervisorial District
Note
Fill in one or more
Data collected on Form
must total 100.
Data Type on Form Business Rules
Calculation
Source
number
IF the grantee does not fill out the related report, the percent is zero.
Entered by Grantee
Supervisorial District 1 ___ %
Number
Sum of percents must = 100
Project Outcome Focus Direct Services
Supervisorial District 2 ___ %
Number
Supervisorial District 3 ___ %
Number
Supervisorial District 4 ___ %
Number
Supervisorial District 5 ___ %
Number
2
DS2 Direct Services
Service Type 1 Service Type 2 Service Type 3 Service Type 4 Service Type 5
Provide a 1-2 sentence description of the services your organization provides.
Service Type 1 Service Type 2 Service Type 3 Service Type 4 Service Type 5
Text Text Text Text Text
Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee
3
DS3 - Direct Services DS6
Service Type 1
How many clients received the services below during the most recent reporting period?
Children ages 0-5
Number
Entered by Grantee
Parents with Children ages 0-5 Other family members of children ages 0-5 Providers serving children ages 0-5 and their families
Number Number Number
Entered by Grantee Entered by Grantee Entered by Grantee
Children ages 0-5 Parents with Children ages 0-5 Other family members of children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Other family members of children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Other family members of children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Other family members of children ages 0-5 Providers serving children ages 0-5 and their families AVERAGE number of hours of services EACH Service Type 1 avg number of hours client received during the reporting period (Jan - Service Type 2 avg number of hours June) Service Type 3 avg number of hours Service Type 4 avg number of hours Service Type 5 avg number of hours New Clients for this reporting period Children ages 0-5 Parents with Children ages 0-5
Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number
Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Calculated Calculated
Service Type 2
Service Type 3
Service Type 4
Service Type 5
4
DS4 Direct Services
7
DS7 Direct Services DS8
Service Type 1 Service Type 2 Service Type 3 Service Type 4 Service Type 5 Client Total
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The total should be the same here, by language, by race, by age. Count from categories below.
Add Jul-Dec & Jan-Jun for FY total
First 5 LA Project Grantee Collection Data Q# on Form
OG
Section on Form Name on Form
Note
Ethnicity
Count from categories below
Ethnicity Total Ethnicity Total Ethnicity Total
Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families
Number Number Number
Count from categories below Count from categories below Count from categories below
Calculated Calculated Calculated
Primary Language Total Primary Language Total Primary Language Total
Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families
Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number
Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5
Number Number Number Number
Hispanic/Latino
Pacific Islander
Caucasian/White
Multiracial
Other
Unknown
English
Spanish
Source Calculated Calculated
Black/African American
DS14
Calculation
Count from categories below.
Asian
Primary Language
Add Jul-Dec & Jan-Jun for FY total
Number Number
Alaska Native/American Indian
DS11 - Direct Services DS13 DS12
Data Type The total should be the same here, language, by race, by age. on Form by Business Rules
Other family members of children ages 0-5 Providers serving children ages 0-5 and their families
DS9 DS10 DS11 Direct Services DS12 DS14
Data collected on Form
Page 3 of 10
Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total
Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee
Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total
Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee
Count from categories below Count from categories below Count from categories below
First 5 LA Project Grantee Collection Data Q# on Form
OG
Section on Form Name on Form
Note
Cantonese
Mandarin
Vietnamese
Korean
Hmong
Tagalog
Other
Unknown
DS14 Direct Services
15
DS15 Direct Services
Age Total (age at enrollment) Birth to 1 year old 1 year old 2 years old 3 years old 4 years old 5 years old Unknown Age Leverage
How much money was your organization able to leverage against First 5 LA‘s Direct Services investment ?
Data collected on Form Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Children ages 0-5 Parents with Children ages 0-5 Providers serving children ages 0-5 and their families Age Total (age at enrollment) Birth to 1 year old 1 year old 2 years old 3 years old 4 years old 5 years old Unknown Amount of leverage - what did
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Data Type on Form Business Rules Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number Number (currency)
Calculation
Source
Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total
Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee
Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total Add Jul-Dec & Jan-Jun for FY total
Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee
First 5 LA Project Grantee Collection Data Q# on Form 16
OG
Section on Form Name on Form
Data collected on Form
What are your organization's three most significant accomplishments made as a result of this Direct Services investment during this reporting period.
Accomplishment 1 Description text a. Who was involved? b. What was accomplished? c. Why was this significant? d. Were there any unusual/unique obstacles to overcome? e. Did you receive any recognition for this accomplishment? If yes, please describe. f. (Where applicable) Please share at least one example of how this project affected a system, organizational or policy change that aims to positively impact the lives of young children and families.
Entered by Grantee
Accomplishment 2 Description a. Who was involved? Accomplishment 3 Description a. Who was involved? Narrative Text
Entered by Grantee Entered by Grantee text
Narrative Text
text
Entered by Grantee
Attachment: Address list of New service locations
List of names and associated addresses services given. Probably Excel
Attachment
Entered by Grantee
DSb Direct Services
Attachment: Up to five program officer-requested documents
Can be PDF, word or Excel. Information is open ended. Attachment
Entered by Grantee
OS1 Organizational Support
Organizational Support funding that was used for services in each Supervisorial District
DS16 Direct Services
Accomplishment 1 (Direct Services)
Accomplishment 2 (Direct Services) Accomplishment 3 (Direct Services) DS17 Direct Services DS18 Direct Services Dsa
1
2
Data Type on Form Business Rules
Note
Direct Services
OS2 Organizational Support
organization's most significant challenge in implementing this DS investment What strategies were used to address this challenge?
Count the number of organizations by type of support they received
Choose one or more
Sum of percentages must = 100
Calculation
Source
Supervisorial District 1 ___ %
Number
Project Outcome Focus Organizational Support
Supervisorial District 2 ___ %
Number
Entered by Grantee
Supervisorial District 3 ___ %
Number
Entered by Grantee
Supervisorial District 4 ___ %
Number
Entered by Grantee
Supervisorial District 5 ___ %
Number
Entered by Grantee
Sub-Contracting: Money provided to help support activities and/or services. This would include subcontractors providing services to families.
Number
Entered by Grantee
Sub-contracting: Describe Purpose of Funding
text
Entered by Grantee
Capacity building: Increasing infrastructure, skills and Number resources of an organization to better provide services.
Entered by Grantee
Describe Capacity Building
text
Entered by Grantee
Training: Education or instruction improving staff's ability to perform their job duties.
Number
Entered by Grantee
Describe Training:
text
Entered by Grantee
Page 5 of 10
First 5 LA Project Grantee Collection Data Q# on Form
2
3
OG
Section on Form Name on Form
OS2 Organizational Support
OS3 Organizational Support
Note
AVERAGE number of hours of support EACH organization received (include self). The average number of hours is the average amount of time each organization received the organization support services from your organization.
How many organizations received support from your organization via this First 5 LA investment. Count the number of organizations, by organization type (including self, if applicable).
Data collected on Form
Data Type on Form Business Rules
5
OS4 Organizational Support
OS5 Organizational Support
How many organizations received support from your organization via this First 5 LA investment. Count the number of organizations, by organization size.
How much money was your organization able to leverage against First 5 LA‘s Organizational Support investment ?
A matching grant for capacity building.
Source Entered by Grantee
Describe Partnership Development
text
Entered by Grantee
Evaluation: A diagnosis or study of the value, quality, importance, extent, or condition of something. Describe Evaluation:
Number
Entered by Grantee
text
Entered by Grantee
Other:
Number
Entered by Grantee
Describe Other:
text
Entered by Grantee
Capacity building
Number
Entered by Grantee
Training: Education or instruction improving staff's ability to perform their job duties.
Number
Entered by Grantee
Partnership Development: Establishing relationships for Number and/or working cooperatively with entities to provide services to clients or accomplish another goal in a more comprehensive or collaborative manner.
Entered by Grantee
Evaluation: A diagnosis or study of the value, quality, importance, extent, or condition of something.
Number
Entered by Grantee
Other:
Number
Elementary Schools (P-6, K-6/K-8) Elementary School Districts
Number
Entered by Grantee Count only new addition organizations for this reporting period.
Entered by Grantee
Number
Entered by Grantee
Number
Entered by Grantee
Number
Entered by Grantee
Number
Entered by Grantee
Number 4
Calculation
Partnership Development: Establishing relationships for Number and/or working cooperatively with entities to provide services to clients or accomplish another goal in a more comprehensive or collaborative manner.
Entered by Grantee
Less than $1 Million
Number
$1 Million- $10 Million
Number
$10 Million- $20 Million
Number
Entered by Grantee
$20 Million- $50 Million
Number
Entered by Grantee
More Than $50 Million
Number
Entered by Grantee
Unknown Budget
Number
Entered by Grantee
Dollar Amount
Currency
Entered by Grantee
Page 6 of 10
Count only new additional organizations for this reporting
Entered by Grantee Entered by Grantee
First 5 LA Project Grantee Collection Data Q# on Form 6
OG
Section on Form Name on Form
OS6 Organizational Support
Accomplishment 1 (Organizational Support)
Data collected on Form
What are your organization's three most significant accomplishments made as a result of this organizational support investment during this reporting period.
Accomplishment 1 Description text a. Who was involved? b. What was accomplished? c. Why was this significant? d. Were there any unusual/unique obstacles to overcome? e. Did you receive any recognition for this accomplishment? If yes, please describe. f. (Where applicable) Please share at least one example of how this project affected a system, organizational or policy change that aims to positively impact the lives of young children and families.
Entered by Grantee
Accomplishment 2 description a. Who was involved? b. What was accomplished? Accomplishment 3 Description a. Who was involved? b. What was accomplished?
text
Entered by Grantee
text
Entered by Grantee
text
Entered by Grantee
text
Entered by Grantee
Attach
Entered by Grantee
Accomplishment 2 (Organizational Support) Accomplishment 3 (Organizational Support) 7
OS7 Organizational Support
8
OS8 Organizational Support Organizational Support
1
2
SC1
SC2
Data Type on Form Business Rules
Note
What was your organization's most significant challenge in implementing this organizational support investment in Jan - June 2013? What strategies were used to address this challenge?
Calculation
Source
Attachment: Address list of new service locations
Upload a spreadsheet containing the addresses at which the organizations you supported do their work (provide services). Include your own organization.
Organizational Support
Attachment: Up to five program officer-requested documents
Can be PDF, word or Excel. Information is open ended. Attachment
Systems Change
% of Systems Change funding that was used for services Choose one or more in each Supervisorial District
Supervisorial District 1 ___ %
Number
Supervisorial District 2 ___ %
Number
Entered by Grantee
Supervisorial District 3 ___ %
Number
Entered by Grantee
Supervisorial District 4 ___ %
Number
Entered by Grantee
Supervisorial District 5 ___ %
Number
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Systems Change
2. Which of the following systems has your organization Choose one or more worked to change or improve
services
Page 7 of 10
Entered by Grantee
Fill in for new grantees. Sum of percents must = 100
Project Outcome Focus Systems Change
First 5 LA Project Grantee Collection Data Q# on Form
OG
Section on Form Name on Form
Note
Data collected on Form
Describe Other 3
SC3
Systems Change
3. What did your organization do to change the system(s) (choose all that apply)?
Data Type on Form Business Rules
Calculation
Source
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Text Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox Text Checkbox
Entered by Grantee Entered by Grantee Entered by Grantee
community engagement, public/policymaker education) briefs)
distribution, technical assistance)
Describe Other 4
5
SC4
SC5
Systems Change
Systems Change
4. At what level(s) do these organizations seek to make a Choose one or more change?
How much money was your organization able to a. Money leveraged to aid your organization in Dollar Amount leverage against First 5 LA's Systems Change investment all its efforts $ ? b. Money leveraged to support First 5 LA’s Dollar Amount investment to alter the system you sought to change $_______
6
SC6
Will the following questions be answered about children or families?
7
SC7
Approximately how many children or families could potentially benefit from this systems change in the future on yearly basis?
Fill in for new grantees.
Checkbox Checkbox Checkbox Checkbox Checkbox Currency
Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee
Currency
Entered by Grantee
Entered by Grantee
Page 8 of 10
First 5 LA Project Grantee Collection Data Q# on Form
OG
8
SC8
Approximately how many children or families actually benefitted from this systems change Jul 2012-Jun 2013
Entered by Grantee
9
SC9
9. Provide a brief explanation of how you estimated this count.
Entered by Grantee
10
SC10 Systems Change
Accomplishment 1 (Systems Change)
Section on Form Name on Form
Note
What are your organization's three most significant accomplishments made as a result of this Systems Change investment in this reporting period?
Accomplishment 2 (Systems Change) Accomplishment 3 (Systems Change) 11
SC11 Systems Change
What was your project's most significant challenge in implementing this Systems Change investment during this reporting period.
12
SC12 Systems Change
What strategies were used to address this challenge?
Systems Change
Attachments Up to five program officer-requested documents
PO will make the request for documents
Data collected on Form
Data Type on Form Business Rules
Calculation
Source
Accomplishment 1 Description text a. Who was involved? b. What was accomplished? c. Why was this significant? d. Were there any unusual/unique obstacles to overcome? e. Did you receive any recognition for this accomplishment? If yes, please describe. f. (Where applicable) Please share at least one example of how this project affected a system, organizational or policy change that aims to positively impact the lives of young children and families.
Entered by Grantee
Accomplishment 2 Description a. Who was involved? Accomplishment 3 Description
text
Entered by Grantee
text
Entered by Grantee
a. Who was involved?
text
Entered by Grantee
text
Entered by Grantee
Can be PDF, word or Excel. Information is open ended. Attachment
Entered by Grantee Entered by Grantee
CS
Community Stengthening
Activity
Only pick one
☐Organizing community associations ☐Community events, celebrations, fairs ☐Information dissemination (brochures, newsletters, resource guides) ☐Media campaigns (radio, television, print, social media) ☐Public speaking ☐Other community strengthening efforts
Community Stengthening
Topic
pick multiple
Page 9 of 10
Checkbox
Entered by Grantee
Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox
Same list as system change type
Entered by Grantee
Checkbox
Entered by Grantee
Checkbox
Entered by Grantee
First 5 LA Project Grantee Collection Data Q# on Form
OG
Section on Form Name on Form
Note
Data collected on Form
Data Type on Form Business Rules
Calculation
Source
Checkbox
Entered by Grantee
Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox Checkbox
Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee Entered by Grantee
services
Community Stengthening
Audience
pick multiple
Describe Other ☒Children Age 0-5 ☐Parents or Guardians ☐Other Family Members ☐Providers ☐Community-at-large
Community Stengthening
# of Occurances
Checkbox Checkbox Checkbox Checkbox Number
Community Stengthening
Total Size of Audience across all occurances
Number
Page 10 of 10
