BCDEFGHIJKLMNOPQRSTUVWXYZ
1
The University of the State of New YorkPROPOSED AMENDMENT FOR A
2
THE STATE EDUCATION DEPARTMENTFEDERAL OR STATE PROJECT
3
FS-10-A (03/15)
4
5
 = Required Field
6
7
Agency Name:Gorham- Middlesex Central SchoolOntario
8
Mailing Address:4100 Baldwin RdCounty
9
Rushville, NY 14544
10
11
12
13
Agency Code:430901060000002
14
Amendment #:
15
Project Number:5891-21-2190
16
17
Contract #:
18
19
Contact Person:Erica HasselstromTel:585-554-4848
20
21
E-mail Address:ehasselstrom@mwcsd.org
22
INSTRUCTIONS
23
● Submit the original and two copies directly to the same State Education Department office where budget was mailed. DO NOT submit this form to Grants Finance.
24
● This form need only be submitted for budget changes that require prior approval as follows:
25
● Personnel positions, number and type
26
● Equipment items having a unit value of $5,000 or more, number and type
27
● Minor remodeling
28
● Any increase in a budget subtotal (professional salaries, purchased services, travel, etc.) by more than 10 percent or $1,000, whichever is greater
29
● Any increase in the total budget amount.
30
● Amendment # at top of this page must be completed.
31
● If extra room is needed for explanations, expand the rows using the row breaks on the left.
32
● Do not use the FS-10-A for requesting a project extension.
33
34
CHIEF ADMINISTRATOR'S CERTIFICATION
35
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, & accurate, & the expenditures, disbursements, & cash receipts are for the purposes& objectives set forth in the terms & conditions of the Federal (or State) award. I am aware that any false,fictitious, or fraudulent information, or the omission of any material fact may subject me to criminal, civil, or administrative penaltiesfor fraud, false statements, false claims, or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812).
36
37
38
39
40
Date:Signature:
41
42
43
FOR DEPARTMENT USE ONLY
44
45
Program Approval:Date:
46
47
Finance:
48
LoggedApproved
49
50
SUBTOTALEXPLANATION (Provide same detail as required in
FS-10 Budget)
SUBTOTAL INCREASESUBTOTAL DECREASE
51
15 - Professional SalariesReflect actual summer professional development on ELA Reading Curriculum and Theraputic Crisis Intervention for Schools for teaching staff summer of 2021.$8,588
52
16 - Support Staff SalariesTo reflect actual salary based on raises and cleaners applied.$160
53
40 - Purchased ServicesPer phone Call with Jeri Chapman on May 5, 2022$55,606
54
45 - Supplies & Materials
55
46 - Travel Expenses
56
80 - Employee BenefitsIncrease NYS Employees Retirment from $9720 to $16,224; Increase Social Security form $ 8262 to $13,716; Decrease Health Insurance from $ 37,624 to $16,918. Remaining transferred to 15 and 16.$46,858
57
90 - Indirect Cost
58
49 - Boces Services
59
30 - Minor Remodeling
60
20 - Equipment
61
Total Increase or Decrease:(+) $55,606(-) $55,606
62
63
Net Increase or Decrease:$0
64
65
ENTER BUDGET >Previous Budget Total:$1,273,281
66
67
Proposed Amended Total:$1,273,281
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100