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The University of the State of New YorkPROPOSED AMENDMENT FOR A
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THE STATE EDUCATION DEPARTMENTFEDERAL OR STATE PROJECT
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FS-10-A (03/15)
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 = Required Field
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Agency Name:Gorham Middlesex CSDOntario
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Mailing Address:4100 Baldwin RoadCounty
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Rushville, NY 14544
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Agency Code:430901060000001
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Amendment #:
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Project Number:5218213005
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Contract #:
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Contact Person:Erica HasselstromTel:585-554-4848 x1807
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E-mail Address:ehasselstrom@mwcsd.org
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INSTRUCTIONS
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● 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.
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● This form need only be submitted for budget changes that require prior approval as follows:
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● Personnel positions, number and type
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● Equipment items having a unit value of $5,000 or more, number and type
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● Minor remodeling
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● Any increase in a budget subtotal (professional salaries, purchased services, travel, etc.) by more than 10 percent or $1,000, whichever is greater
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● Any increase in the total budget amount.
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● Amendment # at top of this page must be completed.
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● If extra room is needed for explanations, expand the rows using the row breaks on the left.
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● Do not use the FS-10-A for requesting a project extension.
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CHIEF ADMINISTRATOR'S CERTIFICATION
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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).
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Date:Signature:
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FOR DEPARTMENT USE ONLY
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Program Approval:Date:
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Finance:
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LoggedApproved
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SUBTOTALEXPLANATION (Provide same detail as required in
FS-10 Budget)
SUBTOTAL INCREASESUBTOTAL DECREASE
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15 - Professional SalariesTransfer from 40 - 3 McKinney Vento Case Managers for 3 buildings at $40 per hour, 1 hour per week for 40 weeks for 2 years. ($4800 per year; $9600 for two years)$9,600
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16 - Support Staff SalariesTransfer from 45 - 1 McKinney Vento Case Managers for 1 buildings at $40 per hour, 1 hour per week for 40 weeks for 2 years. ($1600 per year; $3200 for two years)$3,200
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40 - Purchased ServicesDecrease to code 15 for McKInney-Vento Case Managers of $9,600
$9,600
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45 - Supplies & MaterialsDecrease to code 16 for McKinney Vento Case Managers $3200; the remaining will be used to buy supplies and store cards at Walmart, as originally budgeted.
$3,200
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46 - Travel Expenses
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80 - Employee Benefits
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90 - Indirect Cost
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49 - Boces Services
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30 - Minor Remodeling
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20 - Equipment
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Total Increase or Decrease:(+) $12,800(-) $12,800
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Net Increase or Decrease:$0
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ENTER BUDGET >Previous Budget Total:$13,682
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Proposed Amended Total:$13,682
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