TIME AND EXPENSE SHEET			        Sheet No.	 ____ of _____

Instructions:	 All donations and cash expenditures should be itemized on these sheets.  Each person who is involved in the program should complete and sign a separate form.  Include dates with each entry.  Only expenditures made within the contract period will be reimbursed.  To be reimbursed for expenditures, DOCUMENTATION is needed to prove the organization has incurred the expense.  Forms of documentation required are copies of receipts, invoices and canceled checks.

Name                                                                                                                                Organization  					                                                                       
    Scope-of-Work								          Miles or	                          Grant Reimbursement   In-kind and/or Cash
     Date     Item Number1     Description of Donation or Expenditure2 	                          	         Hours        x        Rate3      =        Amount         or      Donation Amount

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

     Totals 	                   $                                  $  		 
NOTES:													      	
1See Scope-of-Work from contract for Item Numbers.								       
2Attach receipts, invoices, and copies of canceled checks
 for all cash expenditures listed on this page. (Two BIDS are required for items over $1,000)	       (Transfer these totals to Reimbursement Request Summary Sheet.)
3Rate: $0.53 per mile for travel expenses, $18 per hour for volunteer labor. Only qualified 
professionals may count a higher rate. Their rate and qualifications must be justified in writing.
	 Signature