UNIVERSAL FUNDING APPLICATION
FISCAL YEAR 2017-2018
DETAIL BUDGET FORM
A
TOTAL
PROJECT
COST
EXPENDITURES
I.
ADMINISTRATIVE EXPENDITURES
A. PERSONNEL SERVICES
1. Salaries & Wages
a.
0.25 FTE - Finance Manager
b.
c.
d.
e.
Total Salaries & Wages
B.
$
$
$
$
$
$
22,400.00
22,400.00
2. Employee Benefits
a. FICA Taxes
b. Medicare Taxes
c. Retirement Contribution
d. Life Insurance
e. Health Insurance
f. Dental Insurance
g. Workers' Insurance
h. Unemployment Insurance
I. Other
Total Employee Benefits
TOTAL PERSONNEL SERVICES
$
$
$
$
$
$
$
$
$
$
$
1,388.00
325.00
198.00
365.00
170.00
207.00
2,653.00
25,053.00
OPERATING EXPENDITURES
1. Professional Services
a.
b.
Total Professional Services
$
$
$
-
$
-
$
$
$
$
$
3. Communications Services
a. Telephone
b. Cellular Telephone
c. Postage
d. Messenger Services
e. Express Charges
f. Other
Total Communication Services
FUNDS
REQUESTED
$
-
Agency Name:
Sample Agency
Project Name:
Sample Project
B
SOURCES OF MATCHING FUNDS (50% Minimum)
COJ Public Service Grant
Dept of HUD
United Way
1
2
3
$
-
$
C
IN-KIND
MATCHING FUNDS
(50% Minimum)
$
22,400.00
-
$
22,400.00
$
-
1,388.00
325.00
196.00
365.00
170.00
207.00
2,653.00
25,053.00
$
$
-
$
$
-
$
$
-
$
$
-
$
$
$
$
$
$
$
$
$
$
$
$
-
$
-
$
-
$
-
$
-
-
$
-
$
-
$
-
$
-
$
-
$
$
$
$
$
$
$
-
$
-
$
-
$
-
$
-
$
-
4. Utility Services
a. Electric
b. Water
c. Gas
d. Waste Disposal
e. Other
Total Utility Services
$
$
$
$
$
$
-
$
-
$
-
$
-
$
-
$
-
5. Rentals & Leases
a. Building
b. Land
c. Equipment
d. Vehicles
Total Rentals & Leases
$
$
$
$
$
-
$
-
$
-
$
-
$
-
$
-
6. Insurance
a. Professional Liability
b. Surety Bonds
c. General Liability
d. Auto Insurance
e. Other
Total Insurance
$
$
$
$
$
$
-
$
-
$
-
$
-
$
-
$
-
7. Repair & Maintenance Services
a. Service Contracts
b. Building
c. Equipment
d. Other
Total Repair & Maintenance
$
$
$
$
$
-
$
-
$
-
$
-
$
-
$
-
2. Travel & Per Diem
a. Local
b. Out-of-town
1)
2)
3)
4)
Total Travel & Per Diem
Detail Budget Summary Form
Revised 1/16/2015
Page 1 of 4
UNIVERSAL FUNDING APPLICATION
FISCAL YEAR 2017-2018
DETAIL BUDGET FORM
A
TOTAL
PROJECT
COST
EXPENDITURES
FUNDS
REQUESTED
Agency Name:
Sample Agency
Project Name:
Sample Project
B
SOURCES OF MATCHING FUNDS (50% Minimum)
COJ Public Service Grant
Dept of HUD
United Way
1
2
3
C
IN-KIND
MATCHING FUNDS
(50% Minimum)
8. Printing & Binding
a.
b.
Total Printing & Binding
$
$
$
-
$
-
$
-
$
-
$
-
$
-
9. Promotional Activities
a.
b.
Total Promotional Activities
$
$
$
-
$
-
$
-
$
-
$
-
$
-
10. Other Current Charges & Obligations
a.
b.
c.
d.
e.
Total Other Charges & Obligations
$
$
$
$
$
$
-
$
-
$
-
$
-
$
-
$
-
11. Office Supplies
$
-
12. Operating Supplies
$
-
13. Dues, Subscriptions & Memberships
a.
b.
c.
Total Dues, Subscriptions & Memb
$
$
$
$
-
$
-
$
-
$
-
$
-
$
-
14. Employee Training
a.
b.
c.
d.
Total Employee Training
$
$
$
$
$
-
$
-
$
-
$
-
$
-
$
-
15. Depreciation
a. Building
b. Equipment
c. Vehicle
Total Depreciation
$
$
$
$
-
$
-
$
-
$
-
$
-
$
-
16. Indirect Cost
$
6,228.00
TOTAL OPERATING EXPENDITURES
$
6,228.00
$
-
$
-
CAPITAL EXPENDITURES
1. Computers
2. Office Equipment
3. Office Furnishings
4. Other
TOTAL CAPITAL EXPENDITURES
$
$
$
$
$
$
-
$
-
TOTAL ADMINISTRATIVE EXPENDITURES
$
$
-
C.
Detail Budget Summary Form
Revised 1/16/2015
31,281.00
$
6,228.00
6,228.00
$
-
$
-
$
$
-
$
-
$
$
-
$
-
$
6,228.00
$
25,053.00
Page 2 of 4
UNIVERSAL FUNDING APPLICATION
FISCAL YEAR 2017-2018
DETAIL BUDGET FORM
A
TOTAL
PROJECT
COST
EXPENDITURES
II.
SERVICES TO CLIENTS EXPENDITURES
A. PERSONNEL SERVICES
1. Salaries & Wages
a.
1 Residence Manager
b.
2 FTE & 1 PTE Case Manager
c.
1 FTE & 2 PTE Kitchen Manager
d.
1 FTE Food Service Director
e.
1 PTE Client Services Clerk
Total Salaries & Wages
B.
$
$
$
$
$
$
$
26,500.00
55,029.00
38,980.00
30,000.00
14,706.00
165,215.00
2. Employee Benefits
a. FICA Taxes
b. Medicare Taxes
c. Retirement Contribution
d. Life Insurance
e. Health Insurance
f. Dental Insurance
g. Workers' Insurance
h. Unemployment Insurance
I. Other (Disability Insurance)
Total Employee Benefits
TOTAL PERSONNEL SERVICES
$
$
$
$
$
$
$
$
$
$
$
6,226.00
1,462.00
693.00
8,153.00
438.00
3,100.00
716.00
601.00
21,389.00
186,604.00
OPERATING EXPENDITURES
1. Professional Services
a.
Nurse Practitioner / Mental Health
b.
Total Professional Services
$
$
$
25,500.00
25,500.00
2. Travel & Per Diem
a. Local
b. Out-of-town
1) Bus Tokens
2) Fuel
3)
4)
Total Travel & Per Diem
$
$
$
$
$
$
$
336.00
1,664.00
2,000.00
3. Communications Services
a. Telephone
b. Cellular Telephone
c. Postage
d. Messenger Services
e. Express Charges
f. Other
Total Communication Services
$
$
$
$
$
$
$
500.00
500.00
4. Utility Services
a. Electric
b. Water
c. Gas
d. Waste Disposal
e. Other
Total Utility Services
$
$
$
$
$
$
3,896.00
1,400.00
1,500.00
344.00
7,140.00
5. Rentals & Leases
a. Building
b. Land
c. Equipment
d. Vehicles
Total Rentals & Leases
$
$
$
$
$
6. Insurance
a. Professional Liability
b. Surety Bonds
c. General Liability
d. Auto Insurance
e. Other
Total Insurance
$
$
$
$
$
$
1,000.00
1,000.00
2,000.00
1,100.00
5,100.00
7. Repair & Maintenance Services
a. Service Contracts
b. Building
c. Equipment
d. Other (Security Guard Service)
Total Repair & Maintenance
$
$
$
$
$
13,200.00
4,900.00
12,412.00
30,512.00
Detail Budget Summary Form
Revised 1/16/2015
-
FUNDS
REQUESTED
$
$
$
26,500.00
13,143.00
18,980.00
$
58,623.00
$
$
$
$
$
$
$
$
$
$
$
3,629.00
855.00
297.00
1,608.00
86.00
2,447.00
376.00
329.00
9,627.00
68,250.00
$
$
$
-
-
-
Agency Name:
Sample Agency
Project Name:
Sample Project
B
SOURCES OF MATCHING FUNDS (50% Minimum)
COJ Public Service Grant
Dept of HUD
United Way
1
2
3
$
$
$
$
$
$
$
$
$
$
41,886.00
20,000.00
30,000.00
14,706.00
64,706.00
$
41,886.00
$
-
$
-
64,706.00
$
$
$
$
$
$
$
$
$
$
$
2,597.00
607.00
396.00
6,545.00
352.00
653.00
340.00
272.00
11,762.00
53,648.00
$
$
-
$
$
-
$
23,000.00
$
2,500.00
$
23,000.00
$
2,500.00
$
-
$
$
336.00
1,664.00
$
2,000.00
$
-
$
-
$
-
$
-
$
-
$
-
-
-
-
$
-
$
-
$
500.00
$
500.00
$
$
$
$
3,896.00
1,400.00
1,500.00
344.00
7,140.00
$
-
$
-
$
-
$
$
-
$
-
$
-
$
$
$
-
-
$
$
C
IN-KIND
MATCHING FUNDS
(50% Minimum)
-
-
$
-
$
10,000.00
$
$
12,412.00
22,412.00
-
$
$
$
$
1,000.00
1,000.00
2,000.00
1,100.00
$
5,100.00
$
$
3,200.00
4,900.00
$
8,100.00
Page 3 of 4
UNIVERSAL FUNDING APPLICATION
FISCAL YEAR 2017-2018
DETAIL BUDGET FORM
A
TOTAL
PROJECT
COST
EXPENDITURES
C.
FUNDS
REQUESTED
Agency Name:
Sample Agency
Project Name:
Sample Project
B
SOURCES OF MATCHING FUNDS (50% Minimum)
COJ Public Service Grant
Dept of HUD
United Way
1
2
3
C
IN-KIND
MATCHING FUNDS
(50% Minimum)
8. Printing & Binding
a.
b.
Total Printing & Binding
$
$
$
-
$
-
$
-
$
-
$
-
$
-
9. Promotional Activities
a.
b.
Total Promotional Activities
$
$
$
-
$
-
$
-
$
-
$
-
$
-
$
-
10. Other Current Charges & Obligations
a.
Vehicle Maintenance
b.
Uniforms
c.
Text Books & Materials
d.
Knife Sets
e.
Food
Total Other Charges & Obligations
$
$
$
$
$
$
1,000.00
7,000.00
4,500.00
5,000.00
32,555.00
50,055.00
11. Office Supplies
$
550.00
12. Operating Supplies
$
18,252.00
13. Dues, Subscriptions & Memberships
a.
Printing
b.
Publication
c.
Total Dues, Subscriptions & Memb
$
$
$
$
200.00
200.00
400.00
$
-
$
-
$
14. Employee Training
a.
b.
c.
d.
Total Employee Training
$
$
$
$
$
-
$
-
$
-
15. Depreciation
a. Building
b. Equipment
c. Vehicle
Total Depreciation
$
$
$
$
-
$
-
$
TOTAL OPERATING EXPENDITURES
$
$
-
CAPITAL EXPENDITURES
1. Computers
2. Office Equipment
3. Office Furnishings
4. Vehicles
5. Other
TOTAL CAPITAL EXPENDITURES
$
$
$
$
$
$
$
-
TOTAL SERVICES TO CLIENTS EXPENDITURES
TOTAL PROJECT EXPENDITURES
Detail Budget Summary Form
Revised 1/16/2015
140,009.00
-
$
-
$
$
$
$
1,000.00
7,000.00
4,500.00
5,000.00
$
17,500.00
$
$
32,555.00
32,555.00
$
550.00
$
11,000.00
$
$
200.00
200.00
-
$
400.00
$
-
$
-
$
-
$
-
-
$
-
$
-
$
-
$
-
$
$
-
$
-
$
$
-
$
-
$
7,252.00
72,164.00
-
$
$
67,845.00
-
$
326,613.00
$
68,250.00
$
64,706.00
$
125,812.00
$
67,845.00
$
-
$
357,894.00
$
68,250.00
$
64,706.00
$
132,040.00
$
92,898.00
$
-
Page 4 of 4