Grantsfinancialreport_2017_cw.xlsx
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MSNHA Final Financial Report
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Instructions: Fill out this form & submit it along with reiumbursable expense receipts, paid invoices, and legible front and backs of
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cancelled checks within fourteen days of project's end or as part of a quarterly grant reimbursement. Expenses incurred before the grant was approved and MSNHA
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received the signed contract are not eligible for reimbursement. Download or print this spreadsheet, fill it out, sign it, and scan and save to your
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computer if necessary. Scan expense receipts, paid invoices, and legible fronts and backs of cancelled
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checks and combine with financial report & volunteer forms (if appropriate) into one document saved as YOURORGANIZATION_FINANCIAL_2017.
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Email to msnha@una.edu. Questions? Email Cathy Wood, MSNHA grants administrator, at msnha@una.edu or call (256) 762.5057.
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Grantee:
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Today's date:
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Project title:
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Notes:
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1. Grantee must document a total amount of match that is at least equal to the amount requested for reimbursement.
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2. For each expenditure listed, the grantee must submit documentation of cost (copy of invoice and/or receipt) and documentation of payment (copy of
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front and back of cancelled check). Expenses listed here must be the same as specified in your grant contract.
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3. For mileage reiumbursement, document starting and ending points, miles traveled, and purpose of trip on separate sheet of paper.
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4. For labor reimubursement, document total hours contributed and hourly rates for each individual on separate sheet.
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5. For volunteer reimbursement, calculate $23 per hour per volunteer.
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6. Both front and back of each cancelled check must be submitted and must be legible and readable.
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Certification by Financial Officer or Authorized Representative
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I certify that the expenditures and matching contributions reported below are accurate, legitimate, and necessary for the accomplishment of the grant project.
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Name and TitleDate
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Portion to BePortion to
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ItemVendor/Provider
Check #
AmountReimbursed
Count as Match
Documentation Provided
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Totals0.000.000.00
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