ACS Relief Grant Reporting (South Atlantic Conference)

Name Of Person Submitting This Report * Required

Your Email * Required

Your Phone Number * Required

Which State Is Your Church In? * Required

Your Church Name * Required

Pastor's Name * Required

Pastor's Phone Number * Required

Pastor's Email Address * Required

ACS Leader's Name * Required

ACS Leader's Phone Number * Required

ACS Leader's Email Address * Required

GRANT * Required

Project Dates * Required

Must be a minimum of 1 week. Maximum 4 weeks

What Was The Goal Of The Project? * Required

What Is The Location Where The Project Took Place * Required

Describe What Actually Happened In The Project * Required

How Many Beneficiaries Did The Project Serve * Required

(# of Households), (# Average Household Size), and (# Total Number of Beneficiaries Served)

List Any Other NON-SDA Volunteer Organizations That You Collaborated With * Required

Briefly Describe Any Contribution And Input The Community Gave To The Project * Required

Did You Receive Complaints From The Individuals You Served, And How Did You Resolve them? * Required

Describe What Went Well And What Did NOT Go Well (Lessons Learned) * Required

Did You Use All The Funds You Received? * Required

Yes

No

Areas Your Project Assisted In * Required

Possible Sectors and Interventions

FOOD SECURITY AND NUTRITION
Hot meals/drinks
Food kits

HEALTH
Distribution of medicine and supplies to Sanatorium/Hospitals
Heating for health facilities
LOGISTICS AND EMERGENCY TELECOMMUNICATIONS
Procurement of tents
Radios, Satellite phones, etc.

SHELTER AND NFIS (NON-FOOD ITEMS)
Heating for shelters
Installation of equipment at shelters
Preparation and repair of shelters

PROTECTION
Evacuation services (transportation from disaster zone to safe locations)

WATER, SANITATION AND HYGIENE
Distribution of hygiene kits
Distribution of water

MPCA – MULTI-PURPOSE CASH ASSISTANCE
Distribution of cash assistance
Cash in Hand
Cash Vouchers
Bank Transfer
Food Voucher
Multi-Purpose Debit Card
Specific-Purpose Voucher Card (i.e. Hardware Store Gift Card)

You May Select All That Apply

Food Security and Nutrition

Health

Logistics and Emergency Telecommunications

Shelter and NFIs (Non-Food Items)

Protection

Water, Sanitation and Hygiene

MPCA - Multi-Purpose Cash Assistance

Budget Of Total Expenditure (Show How You Spent The Money) * Required

(Use This Format)
Budget Area:
Total Dollar Amount:
Comments:

Supporting Pictures and Videos * Required

PLEASE SUBMIT A MINIMUM OF (10) PICTURES AND (2) VIDEOS FOR EACH PROJECT

Additional Supporting Pictures and Videos