NEW JERSEY COUNCIL FOR THE
HUMANITIES GRANTS PROGRAM
FINAL FISCAL FORM
NJCH Grant No.:
Project Title:
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Total Grant Expended:
Total Cost Share:
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Organization:
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Payment to Date:
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Payment Due:
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Section 1 of 3: Project Expenses
BUDGET CATEGORY
Salaries & Benefits
NJCH GRANT
AWARDED1
NJCH GRANT
EXPENDED2
COST SHARE3
TOTAL4
Fees for Project Personnel
Travel & Subsistence
Supplies & Materials
Services
Other (Itemize Below)
TOTAL:5
1
Itemize your grant allocations as originally proposed or formally revised.
Itemize your actual grant allocations.
3
Itemize your actual share of the total project cost, including both cash and in-kind contributions.
4
Total the values in each row. All values must be based on your actual final expenditures, not estimates.
5
Total the values in each column. All values must be based on your actual final expenditures, not estimates.
2
Did your actual allocation of the grant funds (column 2) differ from your approved allocation of the grant funds
(column 1)? ☐ Yes / ☐ No
If yes, please explain:
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Section 2 of 3: Other Funding Sources
Did you receive any earned income (sales, registration fees, royalties, etc.) as a result of this project?
Yes /
No; If yes, please provide amount and source:
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Did you receive any interest income from the investment of NJCH funds?
Yes /
No; If yes, please provide amount and source:
(Interest earned in excess of $250 will be deducted from the balance of the award owed by NJCH.)
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List the source of all cash and in-kind contributions made in support of this project. The total should equal the
cost share figure reported above.
SOURCE
AMOUNT
CASH
IN-KIND
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TOTAL:
Section 3 of 3: Certification
CERTIFICATION: We certify that the foregoing information is true and correct, and that all expenditures were
incurred solely for the purposes of the above numbered grant, during the approved grant period, and in
accordance with the agreed conditions of the award. (Signatures must correspond to those on the grant
application form.)
_____________________________
__________
_____________________________
__________
Signature (Project Director)
Date
Signature (Authorizing Official)
Date
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Name & Title
Name & Title
_____________________________
__________
Signature (Fiscal Officer)
Date
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Name & Title