| Budget Item and Cost Formula |
Purpose/Activity |
ESTIMATED COST |
| Grant Request |
Other Funding (fill out Part B) |
Total |
| 1. Capital Items: Equipment over $500 (List individually with cost) |
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| 2. Materials: Items less than $500 (List individually) |
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| 3. Other Non-Capital Items: Transportation, food, printing, license fees, etc. (List individually) |
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| 4. Contracted Services: Describe Service and identify provider |
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| 5. Staff Time: Substitute Teacher ($110 x days needed), extended employment, etc. |
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6. Other: Please describe |
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