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West Davis & Bergard Foundation
Grantee Report
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Current
General information
Breakdown of Grant Expenditures
Signature
Complete
Please note, failure to return this report by the deadline may affect consideration for future grants. Thank you for your timely report!
Grantee Name
Please provide the name of the organization that received a grant.
Grant Amount
Please provide the amount of the grant that your organization received.
Report Due By
Report Due By: Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Report Due By: Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Report Due By: Year
Year
2023
2024
2025
Please provide the date that your organization's grant report is due by.
Contact Person
Please provide the name of the person that can be contacted in regards to this report.
Contact Phone
Contact Email
Address
Address
Address 2
City/Town
State/Province
- Select -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
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