Funding Request Template by LB8ug2z

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									                                                                  HNHB LHIN
                                                               BUDGET TEMPLATE

                                              Agency Name:
                                              Program Title:
                                             Funding Sector:


                           SECTION A - BUDGET                                12 Month             2012/2013 Prorated Budget
                                                                              Budget
                                                                             Operating       Start Up    Operating       Total
                                                                              Costs           Costs       Costs         Budget
                                              Start Date (DD/MM/YY)
                     Number of months program operational in the year
REVENUE
              Client Fees                                                                                         -           -
TOTAL REVENUE                                                                        -              -             -           -
EXPENSES
              Salaries and Wages 1                                                   -                            -           -
              Benefit Expense                                                        -                            -           -
Total Salaries and Benefits                                                          -              -             -           -
Program Expenses
              Program Supplies                                                                                    -           -
              Medical Supplies                                                                                    -           -
              Contracted Out Services
                                                                                                                  -           -
                                                                                                                  -           -
              Staff Travel                                                                                        -           -
              Advertising and Promotion                                                                           -           -
              Other Program Expenses (please describe)
                                                                                                                  -           -
                                                                                                                  -           -
                                                                                                                  -           -
              Program Equipment 3                                                                   -                         -
Total Program Expenses                                                               -              -             -           -
Operating Expenses
              Office Expenses                                                                                     -           -
              Staff Training                                                                                      -           -
              Rent                                                                                                -           -
              Utilities & Insurance                                                                               -           -
Total Operating Expenses                                                             -              -             -           -
TOTAL EXPENSES                                                                       -              -             -           -
FUNDING REQUESTED                                                                    -              -             -           -

                                                      SECTION B - PROGRAM TARGETS
                                                Program Outputs                            12 Months       2012/13
              Number of Service Recipients
              Number of Units of Service
              Number Personal Support Worker Hours



                                                  1
                                                      SECTION C - SALARY AND WAGE DETAIL
                                                                                            12 Month       Salary
                                                                              Full-Time
              Position Description                                                          Salary For    (excluding
                                                                             Equivalents                   benefits)
                                                                                            ONE FTE
                       1                                                                                          -
                       2                                                                                          -
                       3                                                                                          -
                       4                                                                                          -
                                                                                     -                            -

                                                      3
                                                          SECTION D - PROGRAM EQUIPMENT
                                    Item Description                           Quantity    Unit Cost     Total Cost
                       1                                                                                         -
                       2                                                                                         -
                       3                                                                                         -
                       4                                                                                         -
                                                                                                                 -




                   f492fc2f-0c24-4c6a-bb8c-91e90a563f67.xls                                                                       2/7/2013

								
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