Sample Format for Budget Request - Free Download
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SAMPLE FORMAT for BUDGET
REQUEST
(Name of Project, Date)
Proposed Budget
(Based on a 12-month budget)
A. Direct Salaries and Wages
Personnel
Total $ XXXXXX
Position Title and Name
Annual
Salary
Time
Months
Amount
Requested
(Example--only for Direct Personnel)
Director, Research & Development
Joe Smith
XXX
20%
12 months
XXX
Justification
Director, Research & Development
Joe Smith
Joe Smith has been with NACCHO since 1993. He is responsible for oversight of the
cooperative agreement activities and ensures that all necessary reports/documentation are
submitted accordingly.
B. Direct Staffing Fringe Benefits
Fringe Benefits
Total $ XXXXXX
23% of Total Direct Staff Salaries = Fringe Benefits
