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FY21 Operating Support Grant - Final Report Form

  1. Complete the following form to provide a final report on activities funded by FY21 Operating Support Grants.
    As a partner in community efforts to advance diversity, equity, and inclusion, we are interested in the efforts you are making, the outcomes you are achieving, and the ways that we can continue to support one another. If you have any questions or concerns, contact Jenni Petersen-Brant, Arts & Cultural Affairs Coordinator, at or at 563-690-6059.
  2. Targeted Planning and Outreach*
    Identify whether you were intentional in involving any of the following populations in your planning, marketing, outreach process.
  3. Check the degree to which project/program participants were reasonably representative of the demographic makeup of the community*
  4. Check any ways in which you have participated in Inclusive Dubuque
  5. In a single PDF attachment, provide evidence of funding recognition given to the City of Dubuque related to this project.
    Examples of funding recognition include press releases, direct mail pieces, email newsletters, etc.
  6. Upload at least 1 and up to 4 high resolution images from that can be used by the City for promotional purposes.
    It is understood that appropriate photo releases have been secured and copyright is waived related to any of the images uploaded here.
  7. If photographer credit is required for any of the uploaded images, please provide an additional document noting the filename and the credit notations required.
  8. By checking the "I agree" box below, I certify that the information contained in this report including attachments, reported expenditure and income, and support materials is true and accurate to the best of my knowledge. *
  9. Entering your name here will be considered an electronic signature.
  10. Leave This Blank:

  11. This field is not part of the form submission.