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i <br />Salarien <br />GRANT APPLICATION <br />Page 4 of 7 <br />Rental .`ipactt <br />Equihm_nt <br />Name of Applicant:���, <br />Travel <br />28. <br />14 <br />u <br />ij)li es <br />15. <br />C)ther (:,ecity^rn attachment) - <br />20. TOTAL <br />BUDGET <br />Total (lines 11 --___-----_.-----_ <br />--- ,__ <br />(Include figures from all <br />programs operated) <br />• <br />EXPENDITURES (line -17 ;ind lin(!-30)_ <br />GRANTEE PRO;R;01 F:tiPF.:;SE:t; <br />18. <br />Salaries <br />REVENUE <br />19. <br />lie ntal._S-3acc'_ <br />----------- <br />1. <br />State Grant <br />Travel -- - -- <br />6 <br />2. <br />Cash Match• (no -federal- dfuns, except_revenue�shaa, <br />- <br />-.,acn-- - - -_- <br />allow -ed) 7. •r?u: <br />22. <br />3. <br />4. <br />In -Ki -- <br />In -Kind _ _ _ _ <br />- - - <br />--- --- -- --' <br />- - - -- -- '-' "°- - - "- --- -- -- 7;L. cites <br />- - - <br />'Total (.1 .inUs 18 i.hrouq 22) - - - - - - - - - - <br />-- - - -- --- <br />TOTAL <br />L R <br />--------------_----------- <br />GRANTEE ADMINISTRATIVE EXPENSE <br />S. Salaries <br />6. Rental Sp -ace----------------- ...- --- - -- -- <br />-- <br />7. Trave 1- <br />8, s upJ)li c s <br />9. Other (specify on attachment) <br />10. Total (liner;_S-thr-Uah_9) <br />DELEGATE: ADM7,IISTRATIVE EXPENSE <br />11. <br />Salarien <br />------ <br />---------------------------a-�-�',r-0d� <br />12. <br />Rental .`ipactt <br />Equihm_nt <br />13. <br />Travel <br />28. <br />14 <br />u <br />ij)li es <br />15. <br />C)ther (:,ecity^rn attachment) - <br />16. <br />Total (lines 11 --___-----_.-----_ <br />--- ,__ <br />17. <br />TOTAL i1D,tIt:ISTF;.i..Tl�lt -CO ; S (lrnr_ 10-aiid-Z inc T6 _ - _ <br />- - - F{J <br />EXPENDITURES (line -17 ;ind lin(!-30)_ <br />GRANTEE PRO;R;01 F:tiPF.:;SE:t; <br />18. <br />Salaries <br />`ADPL IN 1 STRAT1VF AND SAVARY FXPI:::SE:S <br />19. <br />lie ntal._S-3acc'_ <br />----------- <br />20. <br />Travel -- - -- <br />_ --- -- <br />21. <br />t _----------------- - -- <br />- -- -- <br />22. <br />- - - - - - - - - - <br />either (:;}>eciiy-on at.i.xchmentJ <br />- - - --- <br />23. <br />- - - <br />'Total (.1 .inUs 18 i.hrouq 22) - - - - - - - - - - <br />-- - - -- --- <br />DELEGATE PROGP.i.:•i <br />24. Salaries <br />25. Renkal . L)acc <br />26. <br />Travel <br />------ <br />---------------------------a-�-�',r-0d� <br />---------- �. - <br />27. <br />Equihm_nt <br />e <br />28. <br />Other <br />(specity on att-achr,, _ <br />29. <br />Total. <br />(lines_24 throuc-1 2llj-------------------_��'�f�'U <br />30. <br />TOTAL <br />PROMIAAI E\PI:;7;;i:S (line 23 and line <br />29) <br />31. <br />TOTAL <br />EXPENDITURES (line -17 ;ind lin(!-30)_ <br />_ _ _ _ _ _ _ _ _ _/�c�y��i�d <br />32. <br />TOTAL <br />`ADPL IN 1 STRAT1VF AND SAVARY FXPI:::SE:S <br />(line- - -17,-18 & 2.4) <br />NOTE: TOTAL REVENUE MUST EQUAL TOTAL EXI'MIDITURES <br />*bine 32 May not exceed 152 of total budget. <br />