| Item |
Amount |
| Salaries & Wages |
$ |
FT / PT |
| (break down by individual position and indicate
full-time or part-time) |
$ |
FT / PT |
| Fringe Benefits & Payroll taxes |
$ |
| Consultants & Professional Fees |
$ |
| Travel |
$ |
| Equipment |
$ |
| Supplies |
$ |
| Printing & Copying |
$ |
| Telephone & Fax |
$ |
| Postage & Delivery |
$ |
| Rent & Utilities |
$ |
| In-kind Expense |
$ |
| Other (specify) |
$ |
|
| Source |
Amount |
| Government grants and contracts |
$ |
| Foundations
Corporations
Earned Income |
$
$
$ |
| United Way, combined federal,
campaign and other federated campaigns |
$ |
| Individual Contributions |
$ |
| Fundraising Events & products |
$ |
| Membership Income |
$ |
| In-kind support |
$ |
| Other (specify) |
$ |
|