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For IMHO local partners to report on their activities and progress
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International Medical Health Organization I.M.H.O.—Canada
A non-political, non-profit, humanitarian organization
A registered not-for-profit organization in Canada
5637 Finch Avenue East, Unit 7, Scarborough, Ontario M1B 2T9, Canada www.IMHOCanada.org
Tel: (416) 321-9555 Email: [email protected]
IMHOCanadaProjectReportForm
Asourlocalpartners,itisnecessaryforyoutoreportbacktoIMHOCanadaontheprogressyouaremakingwithyoureffortsandtoprovideuswithaccuratefinancialrecordsofhowthefundsgiventoyoubyIMHOCanadahavebeenspent.WerequestthatyoufillinthisformtothebestofyourabilityonaQUARTERLYbasis,thefrequencyofwhichdependsontheoveralltimeframeofyourproject.Itisyourresponsibilitytoreportbacktoususingtheformatoutlinedbelow.FutureinstallmentsoffundswillnotbedisbursedwithoutreceiptofthisProjectReportForm.Pleaseensureyouincludethefollowing:
1. PleasefillouttheattachedIMHOCanadaProjectReportFormascompletelyandaccuratelyas
possible.
2. Uponcompletionoftheproject,sendthisformbackwithyourexpensesummary,outlininghowthefundswerespentontheproject.PleaseusetheattachedIMHOCanadaProjectExpenseSummaryFormandfillitinascompletelyandaccuratelyaspossible,unlessyouprefertouseyourownmethodforreportingyourexpenses.
a.IncludecopiesofALLreceiptsrelatedtoprojectexpenses.Ifnoreceiptisavailable,pleasemakeanoteofitintheform.
3. IfthisisthefirstquarterlyIMHOCanadaProjectReportFormyouarefilingandyouhavenot
alreadydoneso,pleasesenditbackwithawrittenacknowledgement(onyourorganizationletterhead,ifpossible)ofreceiptoffundsfromIMHOCanada.Makesuretodatetheletter,andspecifytheamountreceivedfromtheInternationalMedicalHealthOrganization(IMHO)Canadaaswellasforwhatpurposesyouweregiventhefunds.Thisacknowledgementiscriticalforourrecords,sopleasedonotdelay.
Pleasenote,anysignificantchangestotheproject/programasoutlinedinyourproposal,includingprojectbudget,mustbepre‐approvedbytheIMHOCanadaBoardofDirectors.Thankyouforyourcooperationandfortheinvaluableworkyoudo.Pleasecontactusifyouhaveanyquestionsorneedanyclarification,orifyouwouldliketodiscussanyparticularsaboutyourproject.Sincerely,IMHOCanadaBoardofDirectors
International Medical Health Organization I.M.H.O.—Canada
A non-political, non-profit, humanitarian organization
A registered not-for-profit organization in Canada
5637 Finch Avenue East, Unit 7, Scarborough, Ontario M1B 2T9, Canada www.IMHOCanada.org
Tel: (416) 321-9555 Email: [email protected]
ProjectReportFormDate:__________________________________________TitleofProject/Program:________________________________________________________________NameandAddressofOrganization:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Name(s)ofKeyContactPerson(s)forProject:_______________________________________________
PhoneNumber(s):_______________________________________________________________Email(s):_______________________________________________________________________Fax:___________________________________________________________________________
Pleasebrieflydescribetheprogressyouhavemadewiththiseffortinthelastquarter:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Pleasedescribehowthetargetpopulation(s)hasbenefitedfromthiseffortthisquarter:_________________________________________________________________________________________________
International Medical Health Organization I.M.H.O.—Canada
A non-political, non-profit, humanitarian organization
A registered not-for-profit organization in Canada
5637 Finch Avenue East, Unit 7, Scarborough, Ontario M1B 2T9, Canada www.IMHOCanada.org
Tel: (416) 321-9555 Email: [email protected]
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________PleasedescribehowthefundsIMHOCanadahasgivenyouforthisprojecthavebeenused:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Whatchallenges/difficultieshaveyouencountered:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Areyourprojectgoalsstillthesame?(ifnot,pleaseelaborate):________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________OtherInformation/Comments:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
*Pleaseincludeanyphotosoradditionalinformationasyouseefit.
International Medical Health Organization I.M.H.O.—Canada
A non-political, non-profit, humanitarian organization
A registered not-for-profit organization in Canada
5637 Finch Avenue East, Unit 7, Scarborough, Ontario M1B 2T9, Canada www.IMHOCanada.org
Tel: (416) 321-9555 Email: [email protected]
StatementofVerification:Iherebycertify,tothebestofmyability,thatalloftheinformationcontainedinthisformistrueandaccurate.______________________________________________ ___________________SignName Date_________________________________________ ____________________________PrintName Title/Position
International Medical Health Organization I.M.H.O.—Canada
A non-political, non-profit, humanitarian organization
A registered not-for-profit organization in Canada
5637 Finch Avenue East, Unit 7, Scarborough, Ontario M1B 2T9, Canada www.IMHOCanada.org
Tel: (416) 321-9555 Email: [email protected]
AdditionalSpace(usepagesasneeded)_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
International Medical Health Organization I.M.H.O.—Canada
A non-political, non-profit, humanitarian organization
A registered not-for-profit organization in Canada
5637 Finch Avenue East, Unit 7, Scarborough, Ontario M1B 2T9, Canada www.IMHOCanada.org
Tel: (416) 321-9555 Email: [email protected]
ExpenseSummaryForm
Date VendorName Description Amount CopyofReceiptIncluded?(Y/N)
Notes/Comments
International Medical Health Organization I.M.H.O.—Canada
A non-political, non-profit, humanitarian organization
A registered not-for-profit organization in Canada
5637 Finch Avenue East, Unit 7, Scarborough, Ontario M1B 2T9, Canada www.IMHOCanada.org
Tel: (416) 321-9555 Email: [email protected]
Date VendorName Description Amount CopyofReceiptIncluded?(Y/N)
Notes/Comments
