Revised
Grantee:
Project Name:
Project No:
Grant Period:
Period Covered:
Income Received to date: 0
Expenses Incurred to date:
Balance Due:
Grant Amount:
A | B | C | D |
| Category as Approved In Budget* (e.g., salaries, supplies, etc.) | 5-Star Grant Budget | Actual 5-Star Expenses | Additional Partner Contributions |
| 1. Salaries | $4500 | 0 | |
| 2.Benefits | 0 | 0 | |
| 3. Contracted | $2750 | 0 | |
| 4. Supplies | $2250 | 0 | |
| 5. Equipment | $500 | 0 | |
| | | | |
Totals | $10,000 | $10,000.00 | $0.00 |
*Category and TotalWHC Grant Budget $ columns must list all items as approved in the grantagreement. The remaining columns(B,C,D) show only the expenses incurred to date against appropriate budgetitem.
__________________________ Date: ______________