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<br />CONTRIBUTOR SUPPORT FORM <br />NO Family Nutrition Program <br />October 1, 2007 - September 30, 2008 <br /> <br />Your intention to pledge in-kind value to FNP is considered a local match to the Federal dollars that support the <br />Family Nutrition Program. Though your pledge of time or use of equipment does not represent an actual cash outlay by <br />your organization to the FNP program, it is necessary for us to place a monetary value on that pledge in order to receive <br />an equivalent amount of Federal funding. Please assign dollar values consistent with your agency financial records; <br />when in doubt, please assign a conservative estimate. <br />Thank you very much for your pledge to our program. It is essential for our continuing operation to have this <br />demonstration of local community support. <br /> <br />County Cass <br />Contact Person Scott Fredrickson <br />Phone 701-241-1398 <br /> <br />Name of Agency I Fargo Park District <br />E-mail <br /> <br />Value of Personnel Services (Sala <br />Position Title <br /> <br />+ Fringe Benefits) <br />No. of persons <br />in this osition <br /> <br />a X <br />Hourly value <br /> <br />Pia round Staff <br />Administration Staff <br /> <br />fe,o <br />d <br /> <br /> <br />b <br />Estimated hours <br />er ear to FNP <br /> <br />= <br /> <br />C <br />Total Yearly <br />Value <br /> <br />Total Value <br /> <br /> <br />1.50 <br /> <br /> Total Yearly <br /> Value <br />Value of Physical Space (Attach Schedule A AND documentation) <br />. Name of facility: <br />Value of Equipment (Attach Schedule B) <br />Value of Supplies/Materials (Attach Schedule C) <br />Value of Other Resources (Attach Schedule D) <br /> <br />OVERALL TOTAL VALUE 1<$155(:).00 <br /> <br />On behalf of FarQo Park District <br /> <br />we agree to <br /> <br />(Name of Agency) <br />contribute the above in-kind resources to support the Family Nutrition Program during the project year <br />through September 30, 2008. We certify that we have public, non-federal funds/services available for <br />matchi the Fam' utritio rogr and that these funds are not used to match other Federal <br />progr s. <br /> <br /> <br />1c/d';/f <br />Title <br /> <br />rr;/;;/ f/- <br /> <br />g?~ <br /> <br />Date <br /> <br />Revised 1/07 <br />