Form C: Proposed Program Budget CURRENT YEAR PROPOSED GRANT AMOUNT BUDGET YEAR BUDGET BUDGET 2017-2018 Program Budget Only Program Budget Only Requested UW $ Only PROGRAM REVENUE Support from Organization Program Fees Membership Dues Legacies and Bequests Investment Income Sales of Materials Special Events Government Federal – Government State – Government County – Government Municipality – Grants (Specify) Grant United Way of Blair County – Allocations Other United Ways – Misc. Revenue Please list sources: – TOTAL PROGRAM REVENUE PROGRAM OPERATING EXPENSES Salaries Employee Benefits Payroll Taxes, etc. Professional Fees Supplies Telephone Postage Occupancy Equipment Rental and Maintenance Printing/Publications Travel Professional Development Assistance to Individuals Membership Dues Share of Administrative Costs Misc./Capital Expenses Please list if over $500 – TOTAL PROGRAM OPERATING EXPENSES EXCESS (DEFICIT) REVENUE OVER N/A N/A TOTAL The review team will look at Form C in relationship to the financial reports provided for the organization as a whole. If there are variations please provide a brief explanation to clarify any differences. For example: the program shows a deficit on Form
Form C: Proposed Program Budget CURRENT YEAR BUDGET PROPOSED YEAR BUDGET GRANT AMOUNT BUDGET 2017-2018 Program Budget Only Program Budget Only Requested UW $ Only PROGRAM REVENUE Support from Organization Program Fees Membership Dues Legacies and Bequests Investment Income Sales of Materials Special Events Government – Federal Government – State Government – County Government – Municipality Grants (Specify) Grant – United Way of Blair County Allocations – Other United Ways Misc. Revenue – Please list sources: TOTAL PROGRAM REVENUE PROGRAM OPERATING EXPENSES Salaries Employee Benefits Payroll Taxes, etc. Professional Fees Supplies Telephone Postage Occupancy Equipment Rental and Maintenance Printing/Publications Travel Professional Development Assistance to Individuals Membership Dues Share of Administrative Costs Misc./Capital Expenses – Please list if over $500 TOTAL PROGRAM OPERATING EXPENSES EXCESS (DEFICIT) REVENUE OVER TOTAL N/A N/A The review team will look at Form C in relationship to the financial reports provided for the organization as a whole. If there are variations please provide a brief explanation to clarify any differences. For example: the program shows a deficit on Form
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