2014 Budget Form
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2016 Program Budget Form
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Program Name:
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Organization Name:
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Organization Fiscal year:
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Dates of Program Operation:
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Program Revenue
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Specific to the program for which you seek funding
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Actual 2014Budget 2015
% of change from 2014 to 2015
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1. United Way Grant#DIV/0!
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2. Federal Grants#DIV/0!
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3. Government Support#DIV/0!
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4. Foundations/Private Grants*#DIV/0!
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5. In-kind Support*#DIV/0!
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6. Client/Program Service Fees#DIV/0!
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7. Contributions#DIV/0!
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8. Other Revenue*#DIV/0!
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9. Interest/Investment Income#DIV/0!
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TOTAL PROGRAM REVENUE00#DIV/0!
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*Provide sources on a separate page
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Program Expenses
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Specific to the program for which you seek funding
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Actual 2014Budget 2015
% of change from 2014 to 2015
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1. Salaries (program staff)#DIV/0!
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2. Contract Labor#DIV/0!
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3. Benefits/Taxes (program staff)#DIV/0!
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4. Professional Fees#DIV/0!
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5. Supplies#DIV/0!
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6. Travel#DIV/0!
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7. Communitcation (phone, fax, email)#DIV/0!
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8. Occupancy/Utilities#DIV/0!
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9. Affiliate Payments#DIV/0!
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10. Major Property/Equipment Acquition.Rental Maintenance
#DIV/0!
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11. Conference/Training#DIV/0!
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12. Program Administration#DIV/0!
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13. Postage/Shipping/Printing#DIV/0!
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14. Other-List:#DIV/0!
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#DIV/0!
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Total Program Expenses#DIV/0!
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If program runs at a deficit, please explain on a separate page.
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Service Delivery
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Service delivery details how much good is happening in the community because of the program. Providing this information
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helps to clarify the program's outcomes.
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1. A unit of service is uniquely defined by each program. Please provide your program's definition of Unit of Service by completing
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the following sentence: A unit of service for the _______ program is: (i.e. one class or set of classes taken by one client, or the
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number of attendees at a program event).
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2. Please provide the following information on the program's service delivery.
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Units of ServiceActual 2013
Year-End 2014
Estimated 2015
% of change '14-'15
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1. Units of service delivered
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2. # of people served by units of service
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3. Unduplicated count of people served
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Volunteer UtilizationActual 2013
Year-End 2014
Estimated 2015
% of change '14-'15
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# of Volunteers Used in the Program
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# of Volunteer Hours
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INSERT AGENCY BUDGET
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Please provide your agency's overall 2015 budget in the format currently viewed and used by your governing Board of Directors.
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You may send this as a seperate email to the office if necessary or mail in.
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