Organizations can submit their accountability report in one of two ways:
 By email to: [email protected]
Or
 By mail to: Alberta Culture and Tourism
Community Initiatives Program
International Development
905, 10405 Jasper Avenue NW
Edmonton, AB T5J 4R7
May 2017
Accountability Report
International Development Stream
Section A – Contact Information
Name of Organization:
Person who completed this accountability report:
☐ Mr. ☐ Mrs. ☐ Ms. ☐ Other
Name:
Organization Position Title:
Daytime Phone:
Extension:
Email:
Section B – Project Information
Project Title:
Project Location:
City/Town/Village(s):
District/Province(s):
Country(ies):
When did your project:
Start:
End:
Comments:
Does your organization plan to apply for this same project in the future?:
☐ Yes ☐ No
Please explain:
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Section C – Project Impact Results
1. How did the community benefit?
2. How many people benefitted directly from the project? How was this measured (what is the basis for the
figure)?
3. If you had one story you could tell to illustrate the social impact of your grant, what would it be?
4. How was the community involved in the project planning, implementation, and evaluation?
5. How is the project being sustained by the community now that the funding has been spent?
6. What challenges did you encounter during the project?
7. Did you have the same partner throughout the project’s duration?:
☐ Yes ☐ No
If no, please explain:
8. Please provide a brief evaluation of your partner:
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Section D – Project Monitoring
1. Did a representative of your organization visit the project?
☐ Yes ☐ No
Please explain:
2. How did your organization verify funds were used for the stated purpose?
Section E – Financial Reporting
1.
Please download, complete and attach the project budget. The budget template can be found at
https://culturetourism.alberta.ca/community/community-grants/community-initiativesprogram/international-development/docs/id-financial-reporting-project-completion.xlsx
2.
Please also include copies of bank transfer documentation for the amount of the grant and your
organization’s matching that details the transfer of funds to the project location. If bank transfers are
not available, then receipts may be required.
Section F – Government of Alberta
1. What is your level of satisfaction with the CIP International Development Grant Program?
☐ Very satisfied
☐ Neutral
☐ Very dissatisfied
☐ Somewhat satisfied
☐ Somewhat dissatisfied
Please explain:
2. How was the Government of Alberta recognized for its support to your project?
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Section F – Certifications
Use of Photographs, Video, or Quotation
☐ YES, we give permission to the Community Initiatives Program (CIP) within Alberta Culture and Tourism
to use any photograph, video, or quotation provided as part of the final accountability report for the
project. I understand this material may be used in Alberta Culture and Tourism communications and
documentation by CIP and may be made available to the public through a variety of means, including
printed and electronic formats.
☐ NO, we do not give permission.
Conflict of Interest
As indicated in Section 11 of the International Development Guidelines, an individual affiliated with a grant
recipient should not place themselves in an apparent or actual conflict of interest when using the grant
funds. Any conflict of interest must be fully disclosed to Alberta Culture and Tourism. This includes any
relationships between members of the grant recipient group, vendors, and donors.
☐ There were no perceived or actual conflicts of interest in the carrying out of this project.
Or
☐ There was a perceived or actual conflict of interest encountered in the carrying out of this project.
Please describe circumstances and how the conflict was addressed:
Freedom of Information and Protection of Privacy Act
Any personal information provided in this report will be used for the purpose of administering CIP; it is
collected under the authority of section 33 (c) of the Freedom of Information and Protection of Privacy Act
and is protected by the privacy provisions of the Act. Should you have any questions about the collection
of this information, please contact CIP program staff.
Optional
☐ I agree to allow, Alberta Culture and Tourism, on occasion, to contact the applicant as identified
on this accountability report form to provide information about ministry initiatives or
announcements related to the following topics:
a) grant program changes, funding announcements, and opportunities to provide input/opinion
on programs; and
b) awareness of ministry resources available to the nonprofit sector, including ministry sector
events.
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Certification
I certify that the above information is a complete and accurate financial accounting of the project, and that
the funds were expended on the project as approved by the CIP Office. I am a duly authorized
representative having legal and/or financial signing authority.
Signature of Legal Signing Authority
Date
Name of Legal Signing Authority
Title
Daytime Phone:
Email:
Signature of Alberta Representative
(out of province organizations only)
Date
Name of Alberta Representative
Title
Daytime Phone:
Email:
Final Note
The grant recipient may be required to return any unexpended grant funds or grant funds not used for the
purpose for which the grant was approved.
Original documents and receipts must be kept by the grant recipient for seven years as per recognized
accounting principles.
Failure to meet the funding obligations to the satisfaction of the CIP Office is grounds to restrict access to
future funding.
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