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Department of Population Health, Horizon Health Network
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Grant Programs - Budget Worksheet
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Initiative NameNote:
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Contact Person:
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Lead Organization:Please refer to the Application Guide for a list of acceptable and unacceptable expenses
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Date Submitted:Round all numbers to nearest dollar
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What resources will you need to run your program?
What support do you already have (or expect to have) from other sources?
Items to be covered by Grant (office use only)
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List of resources NeededTotal Cost or ValueDescription / DetailsCOIN-G Requested ContributionsDonated Contrabutions from other sourcesSecured?Pending?Where is this support coming from?
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Totals$0.00$0.00$0.00 $ -
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Maximum grant amount is $10000
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