MLK 2021 Grant Recipient In-Kind Contribution Form

MLK Grant Recipient
In-Kind Contribution Form

Due 5pm, Friday, March 1, 2021.

This form must accompany your MLK 2021 Grant Recipient Financial Report form IF you included any in-kind in your project budget. If your budget does not include in-kind contributions, this form is not required.

Project Name

Organization Name

Contact Name

First Name Last Name

Complete Address of organization, including zip code

Date of in-kind contribution (month, date, year)

Value of in-kind contribution

Description of in-kind contribution

Basis for valuation (market value of property; fair market rent; employee rate of pay; rate normally paid for such services; etc.)

Authorized donor signature

*** Please make copies of all project receipts and send them to MLK Commission, Attn: Michael Shermis, PO Box 100, Bloominton IN 47402 (and indicate your agency). You also can scan them and send them electronically to mlk@bloomington.in.gov if you would rather. Submit this form electronically. Thank you.

THANK YOU!

E-mail

MLK Grant RecipientIn-Kind Contribution Form

This form must accompany your MLK 2021 Grant Recipient Financial Report form IF you included any in-kind in your project budget. If your budget does not include in-kind contributions, this form is not required.

Project Information

MLK Grant Recipient
In-Kind Contribution Form