Contract Amendment Request 1. Project Name: 2. Project Number: 3. Funding Amount Requested: Or Funding Amount to Be Returned: 4. Additional In-Kind Amount 5. Description of Request a. Justification of need: b. Briefly describe the proposed use for these funds: c. Targeted population and/or geographic area served: d. Additions to the Work plan: Goal Objective Activity Projected Due Date
e. Additional performance measures: Performance Measure Projection
f.
Detailed budget: Funds Requested from TCC In-kind Total project cost
Budget Category Detail
g. Budget justification: h. Equipment specifications (as applicable).
______________________________________________________________________ Signature Date