PAY BACK

Complete the evaluation form and use the submit button or mail to the address noted below.

Due 10 working days after completion of project.

Name of Project*:

Date of Project*:

Contact Name*:

Phone Number*:

1. Please state the benefits of your project*.

2. What outcomes came out of your project*?

3. What were the characteristics of your project that stands out*?

4. Describe problems or difficulties encountered and changes made, if any, to resolve the problems*.

5. Please detail by line item each of your expenditures and include a copy of any receipts (if you have receipts you will need to print this completed form and mail along with your receipts to the address below)*.

Return to:
City of Phoenix
Youth and Education Commission
200 W. Washington, 12th Floor
Phoenix, Arizona 85003
(602) 495-0314 Fax: (602) 534-3644

Before you submit this form, we would like you to be aware of the city's policy on the use of its e-mail systems. The policy states that the e-mail message you are about to send: (1) is subject to public disclosure under the Public Records Law, (2) is not private or confidential and (3) is retained for one month.

Last Modified on 09/17/2008 12:58:27