This evaluation form can be used for all grants from Nikau Foundation, including The Tindall Foundation, the Roy and Jan Mace Trust and pass-through grants.

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* 1. Organisation name

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* 2. Name of person completing this form

(By completing this form you certify that the above information is true and correct and that all donation conditions have been adhered to).

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* 3. Grant amount ($)

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* 4. Purpose of this grant

Please respond briefly and concisely (we want you doing great work in the community - not filling in our form).  If you have an internal evaluation report which you can share, please attach - and adjust your responses accordinly (i.e. you can be brief).

With each question we give you an example based on a fictitious animal charity.

Please remember that we ask for supporting documentation to be attached at the end of this form.  We suggest you have this ready before completing the form.  Supporting documentation includes bank statements showing money going into an authorised account, and money coming out (for the purpose of the grant).  We also ask for one or two photos of good resolution which we can publish.  By attaching the photos you are confirming that Nikau Foundation can publish images and consent has been given by anyone in the photo, and that photos are free of royalties.

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* 5. Was the full donation spent for the purpose requested?

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* 6. What inputs and outputs did the grant achieve? 

This is normally described numerically e.g. an additional 500 cats were saved and adopted by 400 families

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* 7. What outcomes and impact did the grants achieve?

This is normally described descriptively e.g. The lives of 500 cats were saved and individuals and more Lower Hutt families enjoyed the comfort of a new pet.  The crazy cat lady has been banned from owning more than 3 cats in future and the newly micro- chipped cats will easily be returned to owners in future if lost.

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* 8. Did you learn anything from your project that you can share with us?

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* 9. How do you evaluate your organisation and services?

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* 10. Please list other funders involved in the project.

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* 11. How can we improve?

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* 12. Please attach copies of your bank statement showing the grant being deposited into the account and proof of the funds exiting the account for the stated purpose.

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* 13. Please attach a photograph

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* 14. Other document upload (or additional photograph)

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* 15. Other document upload (or additional photograph)

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