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SAMPLE BUDGET & BUDGET NARRATIVE Budget XYZ Hospital Type of Grant Contact Person RFP# Address Date Phone Number Itemized List Support Requested Other Contributions 1. Staff $10,000 $ 5,000 2. Fringe benefits @15% $ 1,500 $ 750 3. 2 computers/1 printer $ 6,500 4. Professional dev/travel $ 2,500 Sub totals: $14,000 $12,250 Total project cost: $26,250 Budget Narrative: The _________ hospital is making application to The North Dakota Rural Hospital Flexibility Program for the funding period ______________ to _________________ and the budget is in the amount of $26,250. Personnel: Mary Jones, BSW, community organizer, will coordinate the implementation of community meetings, survey development and dissemination, and fundraising activities. She will provide .5 FTE based on an annual salary of $30,000. Funds in the amount of $15,000 are requested. Fringe benefits: Fringe benefits for the above mentioned position are estimated at 15 percent. Actual benefits will be charged to the project. The amount of $1,500 is requested for fringe benefits. Supplies: Funds are not requested to cover supplies but will be provided as the hospital’s in-kind contribution toward this project. Two computers (2@$2,500) and one printer ($1,500) will be purchased for a total of $6,500. This equipment will be used by the community organizer and her administrative assistant. Professional development/travel: Funds in the amount of $2,500 are requested for training and travel purposes. The community organizer will travel to Washington, DC in October, 2006 to attend a 3-day national training event for community development specialists. Air travel, registration, lodging, meals and material total $2,500.
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