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Project Completion and Evaluation Form

In order for your reimbursement request to be approved for payment, two (2) legible/typed copies of the following items must be provided to the Experience Waterloo, ATTN: Emily Nyren, 500 Jefferson St., Waterloo, IA 50701 within 30 days of completion of the project, or reimbursement may be delayed. One set of the information will be provided to the City of Waterloo by the Experience Waterloo.

  • Evaluation Form – this page – completed fully.
  • Financial summary accounting for all income and expenditures, including matching funds.
  • Copies of invoices. Only itemized and dated invoices can be considered for reimbursement.
    Invoices must be included for both grant funded items and for those used for match.
  • Proof of Payment – To certify proof of payment, submit a photocopy of the check and/or other proof of payment. If cash is used, a receipt with the recipient’s name and signature must also be included.

Step 1 of 2

Address Where Check Should Be Mailed(Required)