2017 Dementia Day Facilities Request for Qualification Proposed Personnel Detail Budget April 1, 2018 to March 31, 2019 Applicant Agency Name: Proposed Program Name: Agency’s Full-Time Equivalent Amount by Fund Source(s) (FTE) = # of Requested Other Other Other Hourly Total Position Name FTE Hours HSD Fund Fund Fund Rate Program Employed Funding Source Source Source Subtotal Salaries & Wages – Personnel Benefits: FICA Pensions/Retirement Industrial Insurance Health/Dental Unemployment Compensation Other Employee Benefits Subtotal Personnel Benefits: – Total Personnel Costs (Salaries & Benefits):
2017 Dementia Day Facilities Request for Qualification Proposed Personnel Detail Budget April 1, 2018 to March 31, 2019 Applicant Agency Name: Proposed Program Name: Agency’s Full-Time Equivalent (FTE) = Amount by Fund Source(s) Position Name FTE # of Hours 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 Other Employee Benefits Subtotal – Personnel Benefits: Total Personnel Costs (Salaries & Benefits):
2017%20DementiaAdultDayFacilities%20RFQ%20Application.docx