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In-Kind Cost Share Certification

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In-Kind Cost Share Certification
UNIVERSITY OF COLORADO AT BOULDER
Certification of IN-KIND Cost Sharing Contributions
_______________________________________________________________________________________
For Completion by Individuals or Organizations Participating in UCB Grant Programs
Thank you for participating in the following grant program at the University of Colorado at Boulder. Federal
and University policies require that we request the following information in order to report to our sponsors
the equivalent monetary amounts for your non-cash contributions. Contributions, to be considered
allowable for reporting purposes, must be incurred during the grant period (listed below) and must be
consistent with the grant sponsor guidelines. Questions regarding allowable costs should be addressed to
the Grant Principal Investigator listed below. Completion examples for this form are on Page 2.
For Individuals: Contributions may include personal time at appropriate rates for the type of services
rendered, communication and transportation costs and miscellaneous expenses incurred in direct
relationship to the grant for which you were not reimbursed.
For Organizations: Contributions include actual costs for staff time and fringe benefits, services, supplies or
other allowable (indirect or administrative costs may be included if you have a federally approved rate)
organization costs which were not reimbursed by the grant.
Grant Title
Grant Sponsor
Grant Award #
Grant Principal Investigator
Grant Period
CONTRIBUTIONS from INDIVIDUALS (rather than from Organizations)
Time Period in which contributions were provided
Personal time:
hours
TIMES Value/Unit:
$
days
months, # of Units:
equals
$
Other Expenses
$
Total INDIVIDUAL contributions
$
CONTRIBUTIONS from ORGANIZATIONS (rather than from Individuals)
Time Period in which contributions were provided
Staff time & benefits
$
Services, supplies, travel, equipment, other etc.
$
Indirect or Facilities and Administrative costs
$
Total ORGANIZATION contributions
$
SIGNATURE REQUIRED
Individual name (printed)
OR, Organization * name
AND signer name (printed)
Signature
* For organization, an administrative officer must sign
Date
RETURN FORM TO
Ver. 2 eff. Dec/09
0.00
0.00
Ver. 2 eff. Dec/09
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