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ND Family Nutrition Program I ~Form^ I <br /> <br />CONTRIBUTOR SUPPORT FORM <br /> <br />October 1, 2004 - September 30, 2005 <br /> <br /> Your gift of a donation or service is considered a local match to the Federal dollars that support the Family <br />Nutrition Program. Auditing guidelines require that the donor information requested below be kept on file by our <br />project administrators. Though your gift 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 gift, in order to <br />receive an equivalent amount of Federal funding. Please assign dollar values consistent with your <br />company/agency financial records; when in doubt, please assign a conservative estimate. <br /> Thank you very much for your gift to our 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 />Cass <br /> Fargo Public Schools - Madison <br /> Chris Triggs <br /> 10400 N 29 St, Fargo <br /> 701-446-5100 <br /> <br />Value of Personnel Services (Salary + Fringe Benefits) <br /> <br /> Position <br />(Name and Title) <br /> <br /> a X b = c <br /> <br />Hourly value Estimated hours Total Yearly <br /> per year to FNP Value <br /> <br />Teachers <br /> <br />Office Staff ( 2 X 5hrs each) <br /> <br /> Principal <br /> <br />$49.30 140 $6902.00 <br />$15.49 10 $154.90 <br />$51.51 5 $257.55 <br />TotalValue $7314.45 <br /> <br />Value of Physical Space <br />include documentation <br /> <br />Name of facility <br /> <br />(Attach completed and signed "Facilities Space Valuation Worksheet" Form B) and <br /> <br /> Total Yearly <br /> Value <br /> <br />Madison <br /> <br />$2586.35 <br /> <br />Total Value $2586.35 <br /> <br /> <br />