Grant Recipient:
Project Title:
Grant Number:	Date:
Date	Time In	Time Out	Staff/Volunteer Name	Activity	No. of Hours Worked (A)	Appropriate Rate (B)	Total In-Kind Contribution (A) x (B)
Total for page
This form must accompany the Request for Reimbursement if volunteer assistance has been provided and constitutes a portion of your project expenditures. Regular staff may complete number of hours worked by date without entering time in and time out when not working during a block of time. Any rates above the established volunteer rate must have documentation that the person is paid that amount and was performing his/her professional job.
Volunteer Name (Print)	Volunteer Signature	Date