Grant Usage Report

Program Name: ___________________________________________
The Gomez and Morris Family Foundation Account #:_______________ 
330141

This form should be used to notify United Charitable of your organization’s grant fund usage and activity for each
quarter in review. Please complete each area and be as detailed as possible. Additional sheets can be attached
if necessary. Grant Usage Reports are due to United Charitable after each quarter – April 30th, July 31st,
October 31st, January 31st. United Charitable reviews and records the reports for rant usage and activity
verification, audit filings and other important processes. If a Grant Usage Report is not received by United
Charitable by the above dates, we will not be able to make any further gifts and the funds will be required to be
returned to United Charitable. 

International Charity Name: _________________________________ 

Centro para el Desarrollo del Potencial Humano Registration #: ____________ 
CDP951212DT7

Grant Award Amount: $____________ 

20,000 (US)    Amount Spent this Quarter: $__________ 
5,000 (US)

 1st Quarter – Due 04/30  2nd Quarter – Due 07/31

For Grant Usage during Jan 1st to March 31st For Grant Usage during April 1st to June 30th

 3rd Quarter – Due 10/31  4th Quarter – Due 01/31

For Grant Usage during July 1st to Sept 30th For Grant Usage during Oct 1st to Dec 31st

I. Progress and Results

1. Describe the progress made this quarter toward the goals and objectives of the grant as described in the grant
application and approval form.
The support in this project has been of great benefit because the children do not interrupt their
therapies and the continuity is what allows us to see results in the medium and long term. The
improvement in children is reflected by the continuity of their therapy programs which have been
created specifically for each of them.

Jesús Esaú Fragosa Juárez

January 2017 admission, at the age of 10 months, with hydrocephalus + valve diagnosis.

2017 At admission he shows high muscle tone in four limbs, with low control and trunk and neck
there is no integration in the midline, with a neurodevelopment scale of 5 months without
2. Detail your problems.
swallowing organization’s activities, services, events (i.e. who you have helped and what help was provided,
what events has your program held). Have you applied for any other funding?
2018 From January to June, he develops greater control in the long sitting, turns remain on the
bench withthe
Basically, good balance,
greatest eventhat
benefit presenting
children weak defense
who attend theininstitution
his lateralreceive
supports initiates
is their
displacement of buttocks pivoting not allowing adaptation to crawling.
comprehensive rehabilitation to be able to integrate with their family, their school and society. Our
July.
main Keeps theisbalance
objective for crawling,
to improve the qualitypresenting it active,
of life of all accepts standing
our beneficiaries with little
and integrate themassistance,
into their
walks with one
community to behand.
ableNovember: Make straightening from lying to bipedal position, try to lift
to live happily.
objects from the ground.
Our services consist of 6 types of therapies that are: physical, language, stimulation, aquatic,
2019 Walker
sensory is placed to
and cognitive; start gear,
a program is manipulates
designed for iteachwithout problem.
of our children according to their potential.
August Starts
In previous the march
years, 5 eventsonly byheld
are one ameter so he
year that is discharged
contribute aboutto32%
integrate
of ourinto the school
annual spending,
process,
these lastreturning
2 years, toduetherapy
to the as an outpatient
COVID-19 and currently
pandemic, we only performs
managedindependent
to carry out 3walking,
of them,
confidence sits in chair
seeing our income of his size,
considerably performs
affected, covered
since we only andmanaged
spoon, already achieves
cover 19% of ourThe removal of
annual
clothing
spending.as well as splints and sphincter control achievement, currently performs the work of
physical therapy for fine coordination and bilateral coordination.
II. Expenditure Responsibility
1. Please account for the past quarter’s large expenses and provide details as to how the expense fulfilled the
grant requirements.
EX. Masonry Bricks & Masons ‐ $2,600 (US) ‐ Masons built the levy that will protect the village from
imminent flooding.

The grant helped us to finish with the objectives set in early 2021 since, due to the pandemic and
isolation, it was essential for us to reinforce the training of parents in order to carry out therapies
via zoom. In the same way, innovative programs, products and services were designed that
added value to our services.

III. Attestation
I certify that I am an authorized officer of the above referenced international charity and that the charitable status
of our organization is still in effect and in good standing with the country in which it is registered. I also certify that
the information provided in this Grant Usage Report is accurate and correct. I understand that the international
charity referenced above must only use granted funds for charitable purposes as described in the grant application
and approval form. I understand that if United Charitable deems that any funding has not been used as indicated
in the application, these funds will be promptly returned to United Charitable upon request. I certify that the
awarded grant funds have not been distributed for use by other individuals or organizations and the funds have
not been used to engage or support any unlawful activities. I certify that the organization named in this report is in
compliance with all statutes, Executive orders, and regulations restricting or prohibiting U.S. persons from
engaging in transactions and dealings with countries, entities, or individuals subject to economic sanctions
administered by the U.S. Department of the Treasury's Office of Foreign Assets Control. Should any change in
circumstances pertaining to this certification occur at any time, the organization will notify United Charitable
immediately. I also certify that awarded grant funding was and will be used according to the laws and regulations
of the country in which we are registered. I have read and understand United Charitable's Charitable Gift
Recommendation Policy and can and will fully comply with all requirements.

6/01/2022
Signature: _______________________________________ Print: ___________________________
ariojasch@hotmail.com
       Email: _______________________________  Phone Number: ______________________ 
52-8184016675

Office Use Only Approved: ________________________ Entry Date: ___________________