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<br />CONTRIBUTOR SUPPORT FORM <br />NO Family Nutrition Program <br />October 1, 2008 - September 30, 2009 <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 Jerry Stigman <br />Phone 446-4700 <br /> <br />Name of Agency I Jefferson Elementary - ~ ~';d'-nrlJ <br />e-mail <br /> <br />Value of Personnel Services (Salary + Fringe Benefits) (Attach documentation) <br />Position Title A x B x C x = D <br /> No. of persons Hourly value Estimated hours Total Yearly <br /> in this Dosition per year to FNP Value <br />Classroom Teachers 18 $61 .14 150 $9,171.00 <br />Office Staff 2 $22.42 8 $179.36 <br />Principal 1 $65.71 4 $262.84 <br />Para Teachers 4 $22.42 35 $784.70 <br /> Total Value $10,397.90 <br /> <br /> Total Yearly <br /> Value <br />Value of Physical Space (Attach Schedule A AND documentation) <br />. Name of facility: Jefferson Elementary $710.57 <br />Value of Equipment (Attach Schedule B) <br />Value of Supplies/Materials (Attach Schedule C) <br />Value of Other In-Kind Resources (Attach Schedule D) <br /> <br />OVERALL TOTAL VALUE I $11,108.471 <br /> <br />Jefferson Elementary <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, 2009 . We certify that we have public, non-federal funds/services available for <br />tching the Famil Nutrition Program and that these funds are not used to match other Federal <br />r grams. <br /> <br />On behalf of <br /> <br />we agree to <br /> <br /> <br />..... <br /> <br /> <br />Revised 3/08 <br />