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Washington State GEAR UP Expenditure Detail FormInsert School District Name Here Insert Month and Year HereDirections: Complete and submit this form with the A19 Invoice Voucher and required backup documentation by the 25th of each month.Salaries, Wages and Benefits Name of Staff MemberStaff Position Title or Reason for Staff PayAssigned Document #ReceiptAmountCategory Total*Sarah CannyGEAR UP Coordinator1$1,245.56Eric HauglandSubstitute for Luke Wallfield to attend UW College visit. 1$112.43Naomi WallaceAfter school tutor in district's GEAR UP program1$347.98Roger SmithDaycare provider for Financial Aid Night1$16.76Subtotal of Salaries, Wages and Benefits $1,722.73Staff Travel and Professional DevelopmentDescribe expenditureName of Activity in Work Plan/PortalAssigned Document #ReceiptAmountCategory Total*The Hilton HotelGEAR UP West lodging, Samson, Clemmons and StrawGEAR UP West2$345.23Will ClemmonsGEAR UP West travel expenses on 09/20-09/21 (mileage, meals and ferry)GEAR UP West3$185.32Tiffany StrawGEAR UP West travel expenses in Seattle, WA on 9/20-09/21 (meals only - rode with Will)GEAR UP West 4$64.00Nick SamsonGEAR UP West travel expenses in Seattle, WA on 9/20-09/21 (meals only - drove with Will)GEAR UP West5$64.00Subtotal of Staff Travel and Professional Development $658.55Goods & Services Describe expenditureName of Activity in Work Plan/PortalAssigned Document #ReceiptAmountCategory Total*AlbertsonsFood for family night. 44 GU students, 62 GU family members,5 staff.Financial Aid Night, 9/14/14.6$174.85Fred MeyerSnacks for UW field trip: 20 GEAR UP students, 3 staffCollege Visit – UW, 9/7/14.7$15.65Office DepotGEAR UP office supplies N/A Consumable supplies8$45.32Office DepotBinders and paper: N/A Consumable supplies9$69.32School District NameField trips meals for 32 students, Flight Museum, 9/18/1410$256.00Subtotal of Goods and Services $561.14Student TransportationDescribe expenditureName of Activity in Work Plan/PortalAssigned Document #ReceiptAmountCategory Total*School DistrictTransportation Dept.(This can include driver time and pay)20 students and 3 staff to UWCollege Visit – UW, 9/7/14.11$189.10Subtotal of Student Transportation $189.10Total Direct CostsTotal Direct Costs from Each Category Above$3,131.52Indirect CostsCalculationTotal Direct CostsRateTotalSchool District Federal Restricted Rate x Total Direct Costs$3,131.523%$92.69Total ReimbursementRequestedTotal Direct Costs + Total Indirect Costs (lines 77+81)$3,224.21*Transfer the category subtotals to the A19 Invoice Voucher. ................
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