Public Squared Grant Budget Request Form

P U B L I C S Q U A R E D G R A N T B U D G E T R E Q U E S T F O R M Please round off figures to the nearest dollar.

OUTRIGHT OUTRIGHT COST-SHARE CHALLENGE TOTAL MH Funds COST-SHARE COST-SHARE MH funds Matching LINE Requested Cash In-kind Requested Gifts TOTAL [1] [2] [3] [4] [5] [6] A. Project Director

B. Fiscal Agent

C. Secretary, Other Staff

D. Planning Committee

E. Speakers, Panelists

Humanities Scholars

F. Researchers, Consultants, Writers, Technicians

G. Telephone, Postage, Shipping

H. Supplies, Printing, Duplicating

I. Promotion, Publicity

J. Travel, Meals, Lodging

K. Equipment Rental, Materials

L. Rental of Space, Custodial Service

M. Indirect Costs (please itemize)

N. Evaluation

O. Other (explain)

TOTALS

Complete budget explanation (next page) that explains each line item for the first five columns and the sources of the cost-share.

* Outright Funds: the total for the Cash Cost-Share column (2) must equal or exceed 10% of total requested (1). Line items need not be matched equally, but the total Cost-Share (2+3) should equal or exceed the total Outright Funds Requested. Challenge Funds: The foundation’s current Challenge Grant ratio is one Mass Humanities dollar for each two dollars in eligible gifts. P R O J E C T G R A N T B U D G E T E X P L A N A T I O N Please show how you arrived at each of the numbers on the budget. Include from where the funds come (source). Feel free to add lines. CHALLENGE CHALLENGE MH FUNDS REQUESTED COST-SHARE Cash [source] COST SHARE In-kind MH FUNDS REQUESTED MATCHING GIFTS $ 500= Joanne Bartleby, 10 $350 = Ishmael Jackson, 7 $ 3,000 youth stipend $5,000 -- [source: Billy $1250 (estimate website hrs bookkeeping @ $50 hrs storytelling @$50 ($10x20 hrs x15 discussion Budd Youth Fund] design, Melville Design [source: Coffin Family (volunteer) sessions) -- EXAMPLE Associates) Foundation]

A Project Director

B Fiscal Agent

Secretary, Other C Staff

Planning D Committee

E Speakers, Panelists

Humanities Scholars

Other Researchers, Consultants, Writers, F Technicians

Telephone, G Postage, Shipping

Supplies, Printing, H Duplicating

Promotion, I Publicity

Travel, Meals, J Lodging Equipment Rental, K Materials Rental of Space, Custodial L Service

Indirect Costs M (please itemize)

N Evaluation

O Other (explain)