2016 Youth Mental Health Counseling Services Request for Proposal Proposed Personnel Detail Budget January 1, 2017 to December 31, 2017 Applicant Agency Name: Proposed Program Name: Agency’s Full-Time Equivalent Amount by Fund Source(s) (FTE) = Requested Other Other Other # of Hourly Total Position Title Staff Name FTE HSD Fund Fund Fund Employed Rate Program Funding Source Source Source Subtotal Salaries & Wages – Personnel Benefits: FICA Pensions/Retirement Industrial Insurance Health/Dental Unemployment Compensation Subtotal Personnel Benefits: – Total Personnel Costs (Salaries & Benefits):
2016 Youth Mental Health Counseling Services Request for Proposal Proposed Personnel Detail Budget January 1, 2017 to December 31, 2017 Applicant Agency Name: Proposed Program Name: Agency’s Full-Time Equivalent (FTE) = Amount by Fund Source(s) Position Title Staff Name FTE # of Employed Hourly Rate Requested HSD Funding Other Fund Source Other Fund Source Other Fund Source Total Program Subtotal – Salaries & Wages Personnel Benefits: FICA Pensions/Retirement Industrial Insurance Health/Dental Unemployment Compensation Subtotal – Personnel Benefits: Total Personnel Costs (Salaries & Benefits):
Youth%20MH%20RFP%20Application%20AMENDMENT%20041816.docx