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REVISED /APPROVED BUDGET Health and WellnessTrust Fund Commission
<br />Grant Application Budget
<br />Applicant Agency:
<br />Contact Person for Budget:
<br />Contact Phone:
<br />Fax:
<br />e -mail:
<br />Federal Tax 1. D. or 501(c)(3):
<br />1. Year 1 starting on or about 1/1/2003 and ending 12/31/2003
<br />2. Year 1 starting on or about 1/112004 and ending 12/31/2004
<br />3. Year 3 starting on or about 1/1/2005 and ending 12/31/2005
<br />1/l/2003--12/31/2003 1 /1 /2004 - -12/31 /2004 1/1/2005--12131/2005
<br />Project Total
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<br />Direct Expenses:...
<br />Sala /Wa es/Benefits
<br />$45,382.00 $8,800.00
<br />$47,272.00 $8,800.00
<br />$49,257.00 $8,800.00
<br />$141,911.00 $26,400.00
<br />Contracted Staff
<br />$0.00 $0.00
<br />Other Please clarify below
<br />$4,000.00 $8,000.00
<br />$4,000.00 $16,000.00
<br />$4,000.00 $16,000.00
<br />$12,000.00 $40,000.00
<br />Subtotal:
<br />$49,382.00 $16,800.00
<br />$51,272.00 $24,800.00
<br />$53,257.00 $24,800.00
<br />$153,911.00 $66,400.00
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<br />Other Than Personnel
<br />Support OTPS
<br />Supplies/Material
<br />$4,000.00 $1,000.00
<br />$4,000.00 $1,000.00
<br />$4,000.00 $1,000.00
<br />$12,000.00 $3,000.00
<br />Communication Costs
<br />(telephone, postage, freight)
<br />$1,217.00 $500.00 $982.00 $500.00 $982.00 $500.00
<br />$3,181.00 $1,500.00
<br />Occupancy Costs (rent,
<br />utilities repairs, maintenance )
<br />$9,600.00 $9,600.00 $9,600.00
<br />$0.00 $28,800.00
<br />Capital Outlay (fumiture,
<br />e ui ment, data processing)
<br />$5,000.00
<br />$5,000.00 $0.00
<br />Other Please clan below
<br />$6,000.00 $4,000.00 $4,000.00
<br />$14,000.00 $0.00
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