Goods and Services In-Kind Form Directions: Donors who provide in-kind donations of services, goods, supplies and travel should complete and sign this form. Name & Job Title School Name: School District: Organization Name & Address: Month & Year: Date of # of Rate per Detailed Description of Services Rendered Total Contribution Hour(s) Hour ($) TOTAL Date of Rate per Detailed Description of Goods and Supplies Provided # of Unit(s) Total Contribution Unit ($) TOTAL Date of Rate per Detailed Description of Travel Incurred # of Mile(s) Total Contribution Mile ($) TOTAL GRAND TOTAL The information listed on this form is an accurate estimate of the services rendered, goods and supplies provided and travel incurred that I have provided to the GEAR UP program. I hereby certify that this information is true and correct. X X Contributor's Signature Date . Complete, scan and send to: Victoria@rgicorporation.com. Originals submitted to local Principal.
Goods and Services In-Kind Form Directions: Donors who provide in-kind donations of services, goods, supplies and travel should complete and sign this form. Name & Job Title School Name: School District: Organization Name & Address: Month & Year: Date of Contribution Detailed Description of Services Rendered # of Hour(s) Rate per Hour ($) Total TOTAL Date of Contribution Detailed Description of Goods and Supplies Provided # of Unit(s) Rate per Unit ($) Total TOTAL Date of Contribution Detailed Description of Travel Incurred # of Mile(s) Rate per Mile ($) Total TOTAL GRAND TOTAL The information listed on this form is an accurate estimate of the services rendered, goods and supplies provided and travel incurred that I have provided to the GEAR UP program. I hereby certify that this information is true and correct. X X Contributor's Signature Date . Complete, scan and send to: Victoria@rgicorporation.com. Originals submitted to local Principal.
goodandservicesinkindform.docx