New Jersey Department of Health

APPLICATION FOR GRANT FUNDS

SCHEDULE A

PERSONNEL COSTS

Name of Applicant

Proposed Grant Title

Date of Application

List all full and part-time paid staff, including fringe benefits. Justify fringe benefit costs on a separate sheet.	Standard Weekly

Work Hours./Employee
IF ADDITIONAL SPACE IS NEEDED, PLEASE USE THE SCHEDULE A FORM THAT IS AVAILABLE ELECTRONICALLY AS AN INDIVIDUAL DOCUMENT.
Position Title	Incumbent Name,

Vacant, or

New Position	Annual Salary	Weekly

Hours on

Project	%

of Weekly

Work Time

On Project	Total

Funds

Needed	Grant Funds

Requested

From State	Funds

From

Other

Sources	STATE

USE ONLY
Sub-Totals
% Fringe Benefits
TOTAL PERSONNEL COSTS

New Jersey Department of Health

APPLICATION FOR GRANT FUNDS

SCHEDULE A

PERSONNEL JUSTIFICATION

Name of Applicant

Proposed Grant Title

Date of Application

List, justify, and submit a curriculum vitae for each position title, excluding clerical and manual positions, in same order as listed on SCHEDULE A: PERSONNEL COSTS. Briefly describe the agency’s personnel policy for salary increases on a separate sheet.
IF ADDITIONAL SPACE IS NEEDED, PLEASE USE THE SCHEDULE A FORM THAT IS AVAILABLE ELECTRONICALLY AS AN INDIVIDUAL DOCUMENT.
Position Title	Minimum Qualifications

(education and experience)

FS-40a

AUG 12	Page 2 of 2 Pages.

FS-40A, schedule a, personnel justification

grant application, FS-40A, schedule a, personnel, fs-40a, fs, financial services, grants management and review GMR

ewhite

2007-04-09

NJDOH