The Maryland Emergency Management Agency The University of Maryland Center for Health & Homeland Security
Regional Catastrophic Preparedness Grant Program Resource Management
IN-KIND DONATION TRACKING FORM
Date: _____________ Individual’s Name: _______________________________ Organization:________________________________________________________ Address:____________________________________________________________ City:____________________________ Telephone Number: (___)________________ State:______ ZIP:_____________
Fax Number: (___)______________
E-mail Address: ______________________________________________________ Website Address: _____________________________________________________
Donation Type (circle one):
PRODUCT
SERVICE End Date: ________________
Performance Period: Start Date: ______________
Product or Service Description (Please describe in detail products or services provided): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ HOURS OF PERFORMANCE: (for donated services only) ____ (Total Hours of Donated Service) X $____ (Estimated Hourly Rate) = $______ (Total InKind Value)
VALUE OF PRODUCT: (for donated products only) $__________ (Total Estimated
In-Kind Value of Products)