Periodic Reporting Format by Grantee

Grantee ID#
Name of Association/Organization
Acronym
Title of Action
Town and Region of Grantee
Reporting Date Number of Reporting Period
Reporting Period
(E.g. 1 of 4)
Date of Submission
A. Progress Towards achieving Objectives
For each of the stated Activities:

State planned activities for the reporting period;

State actual activities carried out during the reporting period for each planned activity;
State who carried out the activity;
Explain the difference between planned activities and actual activities carried out (if any);
Proposed corrective actions to be taken to address performance shortfalls (if any); and
State the results of the implementation of the activities.

A1.1 Planned Activity #1: (state the Activity as contained in the Grant Application)

Answer (20 words)

A1.2 Actual Activity

Answer (30 words)

A1.3 Who carried out the activity

Answer (20 words)

A1.4 Explain the difference between A1.1 and A1.2

Answer (40 words)

A1.5 Proposed Corrective Action if you should do it again.

Answer (30 words)

A1.6 State the results of the implementation of activity

Answer (30 words)

This frame should not be removed

Report no.
Issue no. 3.0
Date of issue Oct 2007 A2.1 Planned Activity #2: (For activity #2 and all other planned
Prepared P.A,, SM,LT, ZUS,DR, KAF activities,. copy and complete the six questions as above in A1)
Checked DR
Approved DR
1
B. Performance Tracking Table by Activity and the Indicators for each activity
(The following table reports on progress made in activity implementation as measured by the agreed activity
indicator for each of the planned activities and subactivities).

B1 B2 B3 B4 B5
Activity Activity Indicator Initial End of Currently
Value Activity achieved
Value Value
#1: Application for
grant
#2. 2.1
2.2
2.3
2.4
#3. 3.1
3.2
3.3
3.4
#4 4.1
4.2
4.3
4.4
#5 5.1
5.2
5.3
5.4
#6 6.1
6.2
6.3
6.4
#7 Internal 7
monitoring &
reporting

2
C. Performance Tracking Table by Intermediate Result and the Indicators for each intermediate result
(The following table reports on intermediate results of the advocacy action as measured by the agreed performance indicators for each of the planned
activities.)

C1 C2 C3 C4 C5 C6
Activity Expected Results Intermediate Initial End of Currently
result Value Activity achieved
Indicator Value Value
#1: Application for grant
#2. 2.1
2.2
2.3
2.4
#3. 3.1
3.2
3.3
3.4
#4 4.1
4.2
4.3
4.4
#5 5.1
5.2
5.3
5.4
#6 6.1
6.2
6.3
6.4
#7 Internal monitoring & 7
reporting

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D1. What contributed to the successful implementation of the activities and why?

Answer (50 Words)

D2. What did not work well during the implementation of the activities and why?

Answer (50 Words)

E. Membership and Dues

Male Female Total

Total Membership of the
Association/organization
Males Female Total
Number of members paying periodic dues

Membership dues per person/period (GH) Amount: Period:

F. Summary Expenditure Report

F1 F2 F3 F4 F5 F6
Planned Activity Initial total Cumulative Total Actual Cumulative Outstanding
budget expenses Expenses Expenses Balance
amount from prior (for balance brought
(GH ) reporting reporting carried forward
period period) forward (GH )
(GH ) (GH )
#1.
#2.
#3.
#4.
#5.
#6.
#7.

G. If you were to carry out the activities again, what would you do differently with respect to
the themes in the table below in order to effectively and efficiently achieve the expected
results?

Planning of activities

Implementation of activities

Choice of targets

Advocacy method and tools used

Service Providers

Participation of your members

Others (specify)

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 H. Planned activities for the next reporting period

H4 Person
H1 H2 H3 responsible for
Planned activity Anticipated Expected results carrying out the
expenditure activity
#1.
#2.
#3.
#4.
#5.
#6.
#7.

I. Endorsement and signature by the Grantee

Date:

Name of the Person who prepared the report:

Signature of Grantees Representative:

Name of Grantees signing Representative:

J. Approval by BUSAC Fund Management

BUSAC Technical comments and/or approval: BUSAC Management comments and/or approval

Signature: Signature:

Date: Date:

Annex 1 Financial Report

by Grantee.xls