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Community Partnership Evaluation Form To be completed by recipients of recurring investments or amounts over $10,000.
Organisations must meet KPIs and reporting deadlines outlined in the KCGM Community Partnership Agreement. An evaluation form must be completed and submitted at each reporting deadline. Failure to do so will result in withdrawal of KCGM support and a request for return of funds.
Evaluation forms must be lodged electronically to [email protected]. Evaluation forms will not be accepted in hardcopy. If you would like help completing the Community Partnership Evaluation Form please contact the KCGM Community Relations Assistant on 9093 3488 to make an appointment.
Contact Details
Name
Position
Organisation
Telephone
Mobile
Project Evaluation
Reporting date:
Project Evaluation report type
Interim
Annual
Final
Project Evaluation report year
Year 1
Year 2
Year 3
Project name
Date/s or term of project
What were the main aims of the project?
2 | KCGM Community Partnership Evaluation Form Version release date 03/09/2012
Were these achieved?
If not, why?
What major activities were undertaken?
Were these the activities outlined in the application?
If not, why?
The following questions address the outcomes and success of the project overall.
a) Did the project meet the community need identified in the application? b) If yes, how was this measured / determined?
c) If no, why?
d) How could the project or activities better meet the identified need?
e) Did the project or activities address an unidentified or additional need?
f) Which parts of the project were particularly successful?
g) Which parts of the project were less successful than others?
h) What needs to be improved if the project is to run in the future?
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What areas of the community did the project reach?
a) Please provide a breakdown of the number of people who attended/participated and the community groups represented
b) How was this information obtained? Provide summary of methods used (eg surveys, interviews)
Please indicate under which category support was sought:
Health
Education and Training
Community Life
Arts and Culture
Environment
How did the project meet the criteria outlined for this category?
Have the Key Performance Indicators been met? Please address each KPI; include any discrepancies between agreed targets and performance and the reasons for this.
KPI 1:
KPI 2:
KPI 3:
KPI 4:
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KPI 5:
What improvements are required to meet KPIs in the future or continue to meet KPIs?
a) How will these changes be implemented?
b) Who will be responsible for implementation of these changes?
c) What opportunities and challenges could influence the future success or continuation of this project?
How was the project resourced and managed?
a) How many staff were involved?
b) What were their roles?
c) Was this approach successful? Why / why not?
d) What improvements need to be made at an organizational level if the project is to continue / run in the future?
e) Who will be responsible for implementation of these changes?
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How was the project promoted to the community?
a) Was this method successful?
Why / why not?
b) How could this be improved in the future?
How was KCGM support acknowledged? Please attach evidence and photographs of the event.
Media releases and outlets
KCGM Logo placement on printed materials
KCGM Logo placement on signage
Verbal acknowledgment of KCGM support
Written acknowledgement (publications and letters)
Other (please specify)
Submitting an evaluation
Please submit the completed evaluation along with any relevant supporting documentation to: Email: [email protected]. Note: Organisations must meet KPIs and reporting deadlines. A Project Evaluation Form must be completed and submitted at each reporting deadline. Failure to do so will result in withdrawal of KCGM support and a request for return of funds.
6 | KCGM Community Partnership Evaluation Form Version release date 03/09/2012
Project Budget Acquittal
Please specify the amount and type of support received from KCGM
Cash:
In kind:
Were all partnership and funding applications successful?
If not, why?
Was the project completed within budget? If not please explain why.
Were there any unexpected costs for the project?
Please complete budget summary. Attach relevant receipts for items funded with KCGM support.
PROJECT INCOME GST Inclusive Non-GST
KCGM Community Partnership
Applicant contribution cash
In-kind (please specify)
Other grants or sponsorships (please specify)
Donations
Fees / Ticket sales
Other income – specify
TOTAL PROJECT INCOME
PROJECT EXPENDITURE
Accommodation and meals
Advertising and publicity
Administration (telephone, postage, stationery)
Artist / Presenters fees
Hire fees Venue
Equipment
Purchases Equipment
Materials
Insurance
Trave, freight and transport
Wages
Other (please specify)
TOTAL PROJECT EXPENDITURE
TOTAL BUDGET SURPLUS / DEFICIT
