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					                                     Budget Revision Request
                              North Carolina Dropout Prevention Grant
(Requests submitted by the 10th of each month will be reviewed by the NCCDP by the 30th of that month.)

Grant Recipient (Name of Organization):                                         Email:

Grant Number:                                                                   Program Director:

Phone:                                                                          Date:


Please provide explanation/justification regarding the request for the budget revision in the space provided below.




Instructions: Please complete the Initial Award Budget column with information from your original proposal.
Complete the first available Revised Budget column that reflects your budget revision request. Both initial award
and proposed revision totals should reflect the same total.

                                     Initial Award           Proposed        Proposed        Proposed
                                     Budget                  Revision        Revision        Revision
Budget Category
                                     Date: (YYYY)            Date: (MM/YYYY) Date: (MM/YYYY) Date: (MM/YYYY)

Personnel 1:                         $                       $                  $                    $

Personnel 2:                         $                       $                  $                    $

Personnel 3:                         $                       $                  $                    $

Personnel 4:                         $                       $                  $                    $

Personnel 5:                         $                       $                  $                    $

Personnel 6:                         $                       $                  $                    $

Personnel 7:                         $                       $                  $                    $

Personnel 8:                         $                       $                  $                    $

Contracted Services 1:               $                       $                  $                    $

Contracted Services 2:               $                       $                  $                    $

Contracted Services 3:               $                       $                  $                    $

Contracted Services 4:               $                       $                  $                    $

TOTAL PERSONNEL & CONTRACTED                         $0.00              $0.00                $0.00                $0.00
SERVICES
Office Supplies & Materials          $                       $                  $                    $
Service Related Supplies             $                       $                  $                    $

                                                                                                                     1
 NCCDP                                                                                                        5/5/2012
TOTAL SUPPLIES & MATERIALS   $0.00   $0.00   $0.00       $0.00




                                                            2
 NCCDP                                               5/5/2012
Travel                                $            $            $            $
Communication & Postage
Utilities
Printing & Binding
Repair & Maintenance
Meeting/Conference Expense

Employee Training (No Travel)

Classified Advertising                $            $            $            $
In-state Board Meeting Expense        $            $            $            $
TOTAL NON-FIXED OPERATION                 $0.00        $0.00        $0.00            $0.00
EXPENSES
Office Rent (Land, buildings, etc.)   $            $            $            $
Furniture Rental (Phones,             $            $            $            $
computers, etc.)
Vehicle Rental                        $            $            $            $
Dues & Subscriptions                  $            $            $            $
Insurance & Bonding                   $            $            $            $
Books/Library Reference Materials     $            $            $            $

Mortgage, Principal, Interest & Bank $             $            $            $
Fees
TOTAL FIXED CHARGES & OTHERS              $0.00        $0.00        $0.00            $0.00
EXPENSES
Building & Improvements               $            $            $            $

Leasehold Improvements                $            $            $            $
Furniture/Non-Computer Equipment $                 $            $            $
($500+ per item)
Computer Equipment/Printers ($500 $                $            $            $
per item)
Furniture/Equipment (Under $500       $            $            $            $
per item)
TOTAL PROPERTY & EQUIPMENT                 $0.00        $0.00        $0.00            $0.00
OUTLAY
Purchases of Services                 $            $            $            $
Contracts with Service Providers      $            $            $            $
Stipends, Scholarships, Bonuses,      $            $            $            $
Grants
TOTAL SERVICES/CONTRACTS                   $0.00        $0.00        $0.00            $0.00
Other 1:                              $            $            $            $
Other 2:                              $            $            $            $
Other 3:                              $            $            $            $
Other 4:                              $            $            $            $
Other 5:                              $            $            $            $
TOTAL OTHER                               $0.00        $0.00        $0.00            $0.00




                                                                                        3
 NCCDP                                                                           5/5/2012
Total Expenditures (This      $0.00   $0.00   $0.00       $0.00
figure MUST equal the total
approved budget for your
grant award.)




                                                             4
 NCCDP                                                5/5/2012
By entering your name and date in the box below, you are certifying that all representations made in this
Budget Revision Request are true and correct to the best of your knowledge. This serves the same purpose
as a notarized signature.
Program Director Signature:                                              Date:

Finance Officer Signature (if required by organization):                Date:


Requests submitted by the 10th of each month will be reviewed by the NCCDP by the 30th of that month.

E-mail to:
ncdropoutprevention@dpi.state.nc.us
For Office Use Only: By entering your name and date in the box below, you are certifying that "Action" taken
indicated on this Budget Revision Request is correct in accordance with the decision of the NCCDP. This
serves the same purpose as a notarized signature.
Budget Revision                   Date:                                NCCDP Co-Chair Signature:
Action:
Comments:




                                                                                                           5
 NCCDP                                                                                              5/5/2012
               6
NCCDP   5/5/2012

				
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