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Acquittal Form
Acquittal Form
1
Your Details
2
Organisation Details
3
Application Details
Your Details
Name
*
Title*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
First Name*
Last Name*
Position
*
Phone
*
Email
*
Organisation Details
1. Name of Organisation
*
2. Name of Organisation as it appears on your DGR/TCC Certificates
*
3. Website Address (www.yourwebsite.com.au)
*
Application Details
4. Project/ Program Title
*
5. Date of application
*
DD slash MM slash YYYY
6. Amount received from The Pierce Armstrong Foundation (excluding GST)
*
7. Of the amount received, were all funds expended on this program (if no, please provide details)
*
Yes
No
If No please provide details:
8. Details of the Project, including aims and any changes to the project compared to what was outlined in the original application
9. Performance vs KPI’s (please provide details)
10. How many people benefited/ participated in the project? (please provide details)
11. Significant achievements or outcomes resulting from the project/ program (short-term and long-term)
12. Date of this Acquittal
DD slash MM slash YYYY
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