b. Extension Service/FNP grant
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b. Extension Service/FNP grant
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<br />;. <br /> <br />.. J 1 .. <br /> <br />ND Family Nutrition Program <br /> <br />MAY 232003 <br /> <br />Form A <br /> <br />,CONTRIBUTOR SUPPORT FORM <br /> <br />October 1, 2003 . September 30, 2004 <br /> <br />Your gift of a donation or service is considered a local match to the Federal dollars that support the <br />Family Nutrition Program. Auditing guidelines require that the donor information requested below be kept on . <br />file by our project administrators.' Though your gift of time or use of equipment does not represent an actual <br />cash outlay by your organization to the FNP program, it is necessary for us to place a monetary value on that <br />gift, in order to receive an equivalent amount of Federal funding. Please assign dollar values consistent with <br />your company/agency financial records; when in doubt, please assign a conservative estimate. <br />Thank you very much for your gift toour program. It is essential for our continuing operation to have this . <br />demonstration of local community support. ' <br /> <br />County/Site <br />Name of Agency <br />Contact Person <br />Address <br />Phone <br />E-mail <br /> <br />~ ~~~~ t;i;t~~D <br /> <br />I ?t9-7~~ _ <br />If) 2- .If) 3 ~ ~., I ~f,J A....J 1:/ ,")'6'/1) 2- <br />ii\" 7B(-;:,,-"fl-'6I'~ .' <br /> <br />, t-u pf):>~ tJ Ct', 4- ,Nt .I-{$. <br /> <br />Value of Personnel Services (Salary + Fringe Benefits) , .$ <br /> <br />Position Hourly value <br />(Name and Title) <br /> <br /> <br />d~..S7 <br />'.t7 <br /> <br />X b = c <br />Estimated hours Total Yearly <br />per year to FNp Value <br /> 7::; /';/' 'I <br /> --- ,~ <br />, <br /> <br />Total Value <br /> <br />7'3~ <br /> <br />Value of Physical Space (Attach completed and signed "Facilities Space Valuation Worksheet" _ Form B) and <br />include documentation <br /> <br />Total Yearly <br />Value <br /> <br />Name of facility <br /> <br /> <br />t%J ,.9-EJ <br /> <br />Total Value <br /> <br />/ j)tJ. tJ{) <br /> <br />(over) <br /> <br />C:\wpdocs\forms\contribsp .03 <br />
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