EXPENSES: List type of expense and amount (for example, transportation, lodging, food, registration fee). Please be complete.
Type of Expense
1._______________________________________$____________
2._______________________________________$____________
3._______________________________________$____________
4._______________________________________$____________
5._______________________________________$____________
TOTAL EXPENSES...........................................................................$_____________
FUNDING: List sources and amounts.
Mini-Grant Request.............................$____________
Department/Program Contribution.......$____________
Other (Please explain).........................$____________
TOTAL..............................................................................................$______________
Revised 9/95