Mission West Virginia

Emergency Aid Grant Reporting

To be completed and submitted for the total number of children served. Please ensure that the entire population served is accurately documented on this form. For questions, please contact rkinder@missionwv.org or call Rachel Kinder at 304-562-0723

Please document total number for each category.

Person Completing Application

First Name

Last Name

School Name

Date

YYYY

TOTAL Number of Children Served:

Number of Children in Foster Care:

Number of Kinship/ Relative Care:

Gender Identity: Please indicate number served in each category.

Boy

Girl

Other

Please indicate number served in each age range

0-5 years old

6-12 years old

13-18 years old

19 years old +

Race/Ethnicity. Please indicate number served in each category

African American

Hispanic

Asian/Pacific Islander

Native American

Multiracial

Caucasion

Other

Please indicate what items were purchased.

Items may be grouped in categories, ex: 5 clothing items, 10 hygiene sets, etc.

Total Amount Spent

Please share with us any details or success stories related to this award.

Example: How it affected the students served, any specific detail that stands out, a positive impact the funds had, any barriers that you encountered, etc. Provide an overall summary as well as any individual stories you want to share.

For questions, please contact rkinder(at)missionwv.org or call Rachel Kinder at 304-562-0723

Mission West Virginia

Emergency Aid Grant Reporting

Please document total number for each category.

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