Form For Documenting Cost Share

 

 

 

Grant Number                                                                                     

 

 

IN-KIND COST SHARE RECORD

 

This form should be filled out and signed by the contributor as a record of local contribution.

 

Equipment or facilities loaned or services performed:                                                     

 

                                                                                                                                   

 

                                                                                                                                 

                                                                                                                                 

 

Number of hours or days involved:                    hours                                        days

 

Wages or fee you are accustomed to receiving for such services:

 

Total Contribution:                                                                                               

                                                                                                                                   

 

                                                                                                               

Signature                                                        Date