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2. Public Safety & Essential Services Quarterly Reports Form
   Each quarter, agencies that receive funds from the Humboldt County Local Public Safety and Essential Services tax must submit reports to the county on a quarterly basis detailing their expenditures and activities carried out with the funding they have received. This form is used to submit that information.
4. First Name
5. Last Name
7. Phone Number
8. Email Address
10. Agency
    The agency submitting this report
11. Quarter*

    1. 1
    2. 2
    3. 3
    4. 4
15. I. Quarterly Narrative

    Results/Outcomes

    Reponses to questions below can be copy/pasted from the narrative attachment you include at right. Responses are being included here for ease of review.

16. Narrative Report

    Fill out this form, save to your computer then upload it above.

    Please attach PDFs Only

18. 1. Please describe the Measure Z activities completed during this period.*
20. 2. How many people have been served and how?
22. 3. Who has benefitted from the enhanced services?
24. 4. What difference did Measure Z funding make in our community and for the population you are serving?

    Please quantify the short-term impact of your project for the current year. If you have evaluation materials that document outcomes and impacts of your work, feel free to attach them in lieu of answering this or other questions.

26. 5. Please quantify the long-term impacts of your project.

    This would be for the entire time period that Measure Z has funded your project. 

28. 6. Describe any unanticipated impacts of receiving Measure Z funding, positive or negative, not already described above.
32. II. Final Summary Report

    Lessons Learned

34. 1. Describe what you learned based on the results/outcomes you reported above and what, if any, changes you will make based on your results/outcomes.
36. 2. What overall public safety improvements has your organization seen as a result of receiving Measure Z funding?
40. Invoice and Budget Form Submissions
42. Invoice Amount*
43. Invoice

    Fill out this form, save to your computer then upload the invoice above and the budget to the right.

    Please attach PDFs Only

    
    

44. Additional Attachment 1

    Please attach PDFs Only

    
    

46. Total Budget*
47. Budget

    See "Invoice" directions to the left. 

    Please attach PDFs Only

48. Additional Attachment 2

    Please attach PDFs Only

    
    

50. Additional Attachments

    If you need to submit more attachments than this form allows, please submit what you can and fill out another form.

54. Communication with Community
56. Have you posted your quarterly update to social media?*

    1. Yes
    2. No
57. Exhibit D of your agreement discusses social media reporting requirements
    Example social media posts could read: “#MeasureZ update: Over the last quarter we [____brief description of Measure Z activities completed and/or total numbers served____]. During our efforts this quarter we’ve seen [____brief description of the difference Measure Z funding has made in our community and for the population you are serving____].
59. Please include a link to your post, or the platform and account name where you posted your update.*
61. If you do not have a social media account, how have you informed the community of your progress in regards to Measure Z?*
63. Photo Uploads

    Please provide any photos you have related to your Measure Z project. Please note that any photos you provide may be shared by the county, and does not replace your requirement to communicate about your Measure Z project, per the terms of your MOU with the county. By uploading photos, you are confirming that any people photographed have either agreed to have their photos taken and shared publicly, or doing so is allowed by law. 

64. Caption your photo

    Please provide a caption for your photo that identifies any individuals who are in the photo, and the action and context of the photo. And please make sure to credit the photographer.

66. Notes
    Do you have any notes or special instructions for your report submission?
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit Submit and Print

* indicates a required field