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Organizational Budget Form

HSR 240

Organizational Budget
Name of Organization ____________________________________________________
Fiscal Year beginning ____________________ ending __________________________
EXPENSES
PERSONNEL
Salaries
Payroll Taxes
Health Benefits
Pension
Contract Workers
Other (Specify)

Subtotal Personnel
OPERATIONS
Rent / Mortgage
Utilities
Telephone/Fax
Insurance
Office Supplies
Program Supplies
Maintenance Supplies
Postage & Delivery
Professional Service Fees
Training & Development
Consultant Fees
Travel
Printing & Copying
Supplies Purchased for Resale
Equipment
Other (specify)

AMOUNT

REVENUE
Govt Grants/Contracts
Foundations
Corporations
Earned Income
United Way
Other federated campaign
Allied Arts
Fundraising Events/Sales
Membership Income
In-kind Support
Ticket Sales
Individual Contributions
Other (specify)

Subtotal Operations
GRAND TOTAL EXPENSES

GRAND TOTAL REVENUE

AMOUNT

Application Cover Sheet


HSR 240

Application Cover Sheet


(please print or type)
Organization Name _____________________________________________
Address ______________________________________________________
City ______________________________ State ______ Zip ____________
Contact
Person _________________________ Phone ___________ Fax _________
Project Dates:
Beginning ________________________ Ending ______________________
Total Project Budget _________________ Amount of this Request _________________

Brief Description of
Project _______________________________________________________
Geographic Area Served by
Project _______________________________________________________
Primary Target
Population ____________________________________________________

_____________________________ _______________________________
(Please print name of agency CEO)

(Please print name of Board President)

(Signature of Board President, indicating Board approval of this request)

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