The Alexander and Margaret Stewart Trust

Reporting

All Stewart Trust grantees are required to submit an annual report to the Stewart Trust.

General Information

Grantee:(required)
Contact Person:(required)
Address:(required)
Date:(required)
Email(valid email required)
Website
Project Title
Total Estimated Project Cost (year of funding)
Grant Year

Project Directors

Project Director 1
Project Director 2
Telephone
Fax
Email(valid email required)

Estimated Project Funds

Provided by Stewart:
Funds provided by Stewart are what pecentage of total funding?
Provided by you:
Funds provided by you are what pecentage of total funding?
Direct revenues from services rendered (including 3rd party reimbursements):
Funds provided by direct revenue are what pecentage of total funding?
Government contracts:
Funds provided by government contract are what pecentage of total funding?
Other private funding:
Funds provided by private funding are what pecentage of total funding?
Contributions:
Funds provided by contribution are what pecentage of total funding?

Patient Information

Number of patients served by project during grant year
Total number of patients’ visits/consultations
Your total average cost per patient
Please describe method of computation

Program Impact

What beneficial results have occurred due to your programs?
How does this program compare with the impact of your most effective competitors?
Why is your organization well suited to providing these services?
What have you learned from this program?
What further improvements can be made to your program?

cforms contact form by delicious:days

To access the necessary Word form, [Right-Click Here]. When you right-click on the link, you will receive a context menu — from this menu, select ‘Save Target As…” (in Microsoft Internet Explorer) and save the Word document to your hard drive. Once saved, you may open the document using Microsoft Word (versions ‘97 to 2007).

Once completed, please mail the annual report back to the Stewart Trust to form-response@Stewart-Trust.org. Be sure to place the NAME OF THE ORGANIZATION in the SUBJECT LINE of your e-mail.

Questions? Please e-mail ljackson@stewart-trust.org or wbierbower@stewart-trust.org or
call (202) 785-9892.