Grants: Expenditure Summary Form

Grantee Expenditure Itemization Summary Form

Grantee Name*
Organization or business name as it appears on the grant agreement
Grant Number*
Grant number assigned by CARE as it appears on the grant agreement. Grant Numbers are between 11 and 13 digits and may include letters and numbers. Enter all letters and numbers as they were assigned. Please note, if your grant ID is only 11 digits, leave the last two digits blank.)
CARE Grant Cycle*
Please enter the Grant Cycle as assigned by CARE
Reporting Period Year*
Reporting Period Quarter*
Preparer / Contact Name*
First Last
Preparer / Contact Phone*
Preparer / Contact Email*
Expenditure Period Start Date*
For the costs requested for reimbursement in this Grant Payment Request, insert the first dates of the period these costs were incurred
MM slash DD slash YYYY
Expenditure Period Close Date*
For the costs requested for reimbursement in this Grant Payment Request, insert the last date of the period these costs were incurred.
MM slash DD slash YYYY
Expenditures
Expenditure Categories*
Please place a checkbox next to the type of expenditures you will be requesting payment for. Form fields will be filtered by the choices you make.
- Select All
- Construction
- Equipment
- Materials
- Marketing & Sales
- Testing/Certification
- Personnel/Admin
- Matching Funds Expended
Construction*
For Capital Improvement and Micro-grants only. Includes installation. (Expand rows as needed by selecting the "+" icon at the end of each row.)
Vendor and Expense Description Invoice Date Invoice Number Dollar Amount
Construction Subtotal*
Add up all expenses and input the amount below.
Construction - Supporting Documents Upload*
Attach copies of receipts, invoices, or other documents that support the reported expenses. (Only file types .jpg, .png and .pdf are accepted.)
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 24 MB.
Equipment*
Please separate TAX and SHIPPING and include on separate lines. (Expand rows as needed by selecting the "+" icon at the end of each row.)
Vendor and Expense Description Invoice Date Invoice Number Dollar Amount
Equipment Subtotal*
Add up all expenses and input the amount below.
Equipment - Supporting Documents Upload*
Attach copies of receipts, invoices, or other documents that support the reported expenses. For Capital Grant Recipients: Please upload a Photo of the Equipment and 3 Competitive Bids or Sole Source Justification. (Only file types .jpg, .png and .pdf are accepted.)
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 24 MB.
Materials (Includes taxes)*
Please separate TAX and SHIPPING and include on separate lines. (Expand rows as needed by selecting the "+" icon at the end of each row.)
Vendor and Expense Description Invoice Date Invoice Number Dollar Amount
Material Subtotal*
Add up all expenses and input the amount below.
Material - Supporting Documents Upload*
Attach copies of receipts, invoices, or other documents that support the reported expenses. (Only file types .jpg, .png and .pdf are accepted.)
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 24 MB.
Marketing & Sales (Includes taxes)*
For Capital Improvement grants only. Reimbursement is limited to 10% of the total Grant Funds issued. Please separate TAX and SHIPPING and include on separate lines. (Expand rows as needed by selecting the "+" icon at the end of each row.)
Vendor and Expense Description Invoice Date Invoice Number Dollar Amount
Marketing & Sales Subtotal*
Add up all expenses and input the amount below.
Marketing & Sales - Supporting Documents Upload*
Attach copies of receipts, invoices, or other documents that support the reported expenses. (Only file types .jpg, .png and .pdf are accepted.)
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 24 MB.
Testing/Certification (Includes taxes)*
Expand rows as needed by selecting the "+" icon at the end of each row.)
Vendor and Expense Description Invoice Date Invoice Number Dollar Amount
Testing Subtotal*
Add up all expenses and input the amount below.
Testing - Supporting Documents Upload*
Attach copies of receipts, invoices, or other documents that support the reported expenses. (Only file types .jpg, .png and .pdf are accepted.)
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 24 MB.
Personnel/Admin*
Expand rows as needed by selecting the "+" icon at the end of each row.)
Expense Description Hours Rates with Benefits Staff Name(s) Dollar Amount
Personnel/Admin Subtotal*
Add up all expenses and input the amount below.
Personnel/Admin - Supporting Documents Upload*
Attach copies of receipts, invoices, or other documents that support the reported expenses. (Only file types .jpg, .png and .pdf are accepted.)
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 24 MB.
Matching Funds Expended (by your company)*
(Expand rows as needed by selecting the "+" icon at the end of each row.)
Vendor and Expense Description Invoice Date Invoice Number Dollar Amount
Matching Funds Subtotal*
Add up all expenses and input the amount below.
Matching Funds- Supporting Documents Upload*
Attach copies of receipts, invoices, or other documents that support the reported expenses. (Only file types .jpg, .png and .pdf are accepted.)
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 24 MB.
Total Expenses for Reporting Period
Please double check this amount against your records. This is the amount that will be reimbursed regardless of what is listed on your invoice copies.
Certification*

I hereby confirm that the information provided herein is accurate, correct, and complete and that the documents submitted along with this form were for expenses related to CARE Grant eligible expenses. I further understand that any false statements may result in denial of reimbursement and/or revocation of grant awards.

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Grantee Expenditure Itemization Summary Form

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Grantee Expenditure Itemization Summary Form

Expenditures

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