HomeMy WebLinkAbout319_ExtensionRequestForm_4.7.2021Request for Extension
Contract #
Grant recipient (organization)
Project name
Contract administrator (key contact)
Address
Phone
Email address
Current grant expiration date
Requested expiration date
Project schedule
Current
Proposed revision
Grant contract expiration date
Justification for Request:
Revised Project Milestone Schedule
Time Period/Date
Activities (List specific quantifiable outputs or activities that will be achieved during each quarter)
Anticipated funds requested
First Quarter
Jan-Mar 2018
Second Quarter
Apr-June 2018
Third Quarter
July-Sept 2018
Fourth Quarter
Oct-Dec 2018
Fifth Quarter
Jan-Mar 2019
Sixth Quarter
Apr-Jun 2019
Seventh Quarter
July-Sept 2019
Eighth Quarter
Oct-Dec 2019
Ninth Quarter
Jan-Mar 2020
Tenth Quarter
Apr-June 2020
Eleventh Quarter2
July-Sept 2020
Twelfth Quarter
Oct-Dec 2020
SUBTRACT QUARTERS AS NEEDED; TWELFTH = LATEST END DATE POSSIBLE
1 Please show anticipated dollar amount, percent of grant spent that quarter, and cumulative percent of grant spent for project. Quarterly invoices will only be reimbursed up to percent
indicated. Unused funds will carry forward to next quarter.
2 10% of grant will be held until receipt of Final Project Report
Funding Requested (Revised)
Budget Categories
(itemize all categories)
Section
319
Please ensure consistence with quarterly funds breakdown in Milestone table
319 Total
Non-Federal
Match *
Total (with match)
Justification
(Include detailed explanation for each budget line item)
Year 1
Year 2
Year 3
Year 4
319 Total
Year 1
Year 2
Year 3
Year 4
Total
Personnel/ Salary
Fringe Benefits
Supplies
Equipment
Travel
Contractual
Other
Total Direct
Indirect (max. 10% of direct costs, per
40 CFR 35.268)
Annual Totals
Grand Total
% of Total Budget
%
%
100%
*Note: Non-Federal match must be a minimum of 40% of the total project budget