SAMPLE COVER PAGE FOR GRANT PROPOSAL - DOC 10 by rGjysa9S

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									                                   REQUEST FOR BUDGET CHANGE                           FORM: G



GRANT NUMBER: _________________
ORGANIZATION: ____________________________________________________________



                                                                ORIGINAL /
                                EXPENSES:                       REVISED      NEW
                                                                APPROVED     (REQUESTED)
                                                                BUDGET       BUDGET
PERSONNEL


FRINGE BENEFIT (15%)



SUPPLIES (ITEMIZE BY CATEGORY)


EQUIPMENT (ANY EQUIPMENT COSTS THAT EXCEEDS 30% OF THE
DIRECT COSTS MAY REQUIRE FURTHER EXPLANTATION)



TRAVEL (MILEAGE AT IRS RATE)


*MAMMOGRAMS, SONOGRAMS, ETC.
(MEDICARE RATE X NUMBER )


*OTHER EXPENSES (ITEMIZED BY CATEGORY) (CRAFT)



TOTAL GRANT FUND REQUEST

SIGNATURE: _______________________________________________ DATE: _____________________
                      PRINCIPAL INVESTIGATOR/PROJECT DIRECTOR



(TYPED) PRINCIPAL INVESTIGATOR/PROJECT DIRECTOR

TO BE APPROVED BY PMASGKFTC VICE PRESIDENT OF GRANTS
SIGNATURE: _______________________________________________ DATE: _____________________
             VICE PRESIDENT OF GRANTS


*MEDICARE RATE
    GRANTS-09; Page 21; Request For Budget Change; Form G                       21

								
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