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4 <br />40 <br />40 <br />GflANT NAME: U 14P GRANT N <br />AMOUNT OF GRANT: i� 1J <br />DEPARTMENT RECENWG GRANT, h rI Off a Q FT rC I <br />iCONTACT PERSON —tAIN& V �SI •e kCf S PHONE NUM©ER: � Y <br />1. How long is the grata ibt?,y " VirS Starring Date:I // <br />1 U U <br />2. Dow the grant mqun you to fund this fwx:U s after rhe grant is over? —y—yes No <br />3. Does the grant require a match? Yp Na <br />If yes, does the grant allow the match to be in In Kind Seviu_a? —� Yes !R:HO <br />4. Percentage of match to grout ('-I" : n N1 //u�� nt ?-3% ; C%L i LkLd CL ,k 4 -VL, `Z 5 K CCt�1 <br />uW • y { "{ s 3 - L't�c <br />S, Grant notch a®orequired ' 7 <br />6. =the matching funds Doming from (i.e In kind Services; Reserve for Contingency)? <br />7. Does the grant cover capital costs or start-up costs? Yes _NO <br />tr no, how much do you think will be neexltd In Capita Casts Or start Up casts? `� <br />(Mach a detail listing of costs) <br />S. Aro you adding say additiaul positrons utilizing the grant funds? —Yes No <br />YM pl use list. pf additional spate is needed, pleat attach a schedule.) <br />Acs, <br />Description <br />Position <br />y <br />Position <br />Position Position i Position <br />011.12 <br />iarsalsries• <br />-7 <br />S 17 <br />A - r7 <br />011.13 <br />Other Salaries & Ws cs <br />Second Year <br />S I C) <br />S— f <br />012.11 <br />Social Security <br />s <br />Third Year <br />S 1 <br />012.12 <br />Retirement -Contributions <br />724 -_ <br />S 1. <br />Fourth Ycu <br />012.13 <br />Insurance -Life & health <br />s ^`-- <br />C'— <br />S P>5,,771 <br />012.14 <br />Worker's Cam afion <br />ti 0,15 <br />'t" <br />21217 <br />S/Sec, Modirarc Matching <br />Mjli3 <br />9. What is the rota) costcost of lien including benefits, capital, start-up, auto expense, trawl card operating? <br />I Saluy and 6etonta I Operating Costs I Capital 1 Tow Costa <br />1R What is the estimsted exist Of the gram to the omWtyover five ywa? t_� <br />wZym- <br />rfee Cl`ffur /Lat <br />,.— xe ck Ilee-f <br />Si <br />- zl <br />�fS75,71L, avec Syfs <br />1,1 1 i+f-y 3 <br />–toy --111160" 211P <br />Signature of Prep.; cL Date: <br />l <br />Grant <br />Ampex <br />Other Match Costs <br />Not Covered <br />Match <br />TOW <br />Fust Yue <br />S 1 1 7 <br />ORD, r <br />Second Year <br />S I C) <br />S— f <br />s <br />s <br />Third Year <br />S 1 <br />S — <br />s1 <br />724 -_ <br />S 1. <br />Fourth Ycu <br />s -- <br />S 1 '7 7 <br />s ^`-- <br />C'— <br />S P>5,,771 <br />ti 0,15 <br />'t" <br />L <br />rfee Cl`ffur /Lat <br />,.— xe ck Ilee-f <br />Si <br />- zl <br />�fS75,71L, avec Syfs <br />1,1 1 i+f-y 3 <br />–toy --111160" 211P <br />Signature of Prep.; cL Date: <br />l <br />