Project Status Report

AHEAD Program Project Status Report

Project Information

Project Name

Project Number Project Type

Effective Date (date grant awarded by the Bank)

Beginning in 2012, the status report and required documentation must be sent to the Bank within 18 months of the effective date.

Years elapsed since effective date (if applicable) Grant Amount $

Member Institution

Name

Contact Person Title

Address City State Zip Code

E-mail Telephone Number

Project Sponsor

Name

Contact Person Title

Address City State Zip Code

E-mail Telephone Number

Project Status

Describe current status of the project, including what the project has accomplished toward achieving the goals and objectives outlined in the AHEAD application.

Project Status (cont.)

Have other funding sources been committed to the project? Yes No

If Yes, please indicate amounts and conditions of commitment:

Are previously committed funding sources still in place? Yes No

If No, please explain:

Evidence of Use of Grant Funds

Attach current AHEAD budget and copies of final paid invoices, or any other final documentation showing that the grant funds were used as stated in the original application and AHEAD budget.

Please list all documentation attached to this status report to show evidence of use of grant funds:

Certification

The Member and Project Sponsor certify that all information in this status report is correct to the best of their knowledge. They each further agree to provide the Bank with such other information about the project and the use of the grant funds as the Bank may request in its sole, reasonable discretion.

Note: This form must be signed on behalf of the member by an authorized signer in accordance with the member’s authorizations on file with the Bank.