Count Me In Activities Report Form

Due: March 1 to be eligible for awards

Report Receipt Confirmation: Chapter advisers will be emailed within 24 hours of the grant report being submitted. If you do not receive a confirmation, your report was not properly submitted. Contact Montana FCCLA ([email protected]) with questions.

Count Me In Activities Report Form

Chapter*
School Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Chapter Adviser Name*
First Last
Chapter Adviser Email*
Chapter Adviser Phone*
Chapter Member Contact Person*
First Last
Chapter Member Contact Person Email*
Why did you choose to address this issue (100 words or less)?
Please list your project goals and objectives (200 words or less).
Summarize your project including major activities, resources used, and partnerships/collaborations in the space below (500 words or less).*
Number of chapter members involved in the project.
Number of people reached through the project.*
Describe your projects evaluation process and the results (200 words or less).
List media used to promote and report on the project (200 words or less).
Number of people reached through public relations efforts.
Upload up to three photos of your project in action.*
Drop files here or

Max. file size: 50 MB.
Provide a brief description of each photo.
Optional: Upload up to 5 supporting files, such as promotional pieces (flyers, print ads, PSA’s, etc) and public relations materials that help to tell the story of your project.
Drop files here or

Max. file size: 50 MB.
By submitting this form, I confirm that: - All information is correct to the best of my knowledge. - I have read, and agree to, the program award terms and conditions. - Montana FCCLA and their partners may use pictures on their website and social media accounts for promotional purposes.*
- Yes
- No

Count Me In Activities Report Form

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