New Jersey Department of Health	SCHEDULE C

APPLICATION FOR GRANT FUNDS	OTHER COST CATEGORIES

Name of Applicant

Proposed Grant Title

Date of Application

List other cost categories applicable to grant proposal, such as travel, supplies, equipment, and other direct expenses. A copy of lease agreement, travel regulations, and any other pertinent agreement is to be attached when requesting funds for these budget categories.
IF ADDITIONAL SPACE IS NEEDED, PLEASE USE THE SCHEDULE C FORM THAT IS AVAILABLE ELECTRONICALLY AS AN INDIVIDUAL DOCUMENT.
Other Cost Categories

(specify)	Basis for Cost Estimate	Total

Funds

Needed	Grant Funds

Requested

From State	Funds From

Other Sources	STATE USE ONLY
A.
B.
C.
D.
E.
TOTAL COSTS

New Jersey Department of Health	SCHEDULE C

APPLICATION FOR GRANT FUNDS	OTHER COST JUSTIFICATION

Name of Applicant

Proposed Grant Title

Date of Application

Justify below all items or services which are listed in SCHEDULE C: OTHER COSTS. Justify the items or services in the same order as they are listed on the schedule. Attach copy of lease agreement when requesting funds for rent. The cost allocation method should be included in the justification if a cost category is distributed among multiple funding services.
IF ADDITIONAL SPACE IS NEEDED, PLEASE USE THE SCHEDULE C FORM THAT IS AVAILABLE ELECTRONICALLY AS AN INDIVIDUAL DOCUMENT.

FS-40c

AUG 12	Page 2 of 2 Pages.

FS-40C, Schedule C, Other Cost Categories

FS-40c, FS, financial services, schedule C, other cost categories, grant application, grant, GMR

ewhite

2007-04-09

NJDOH