11000

New York State Education Department
Office of Vocational and Educational
Services for Individuals with Disabilities (VESID)

Contract Management Unit

quarterly contract expenditure report
totals for all contract projects

facility:		for vesid use only
prepared by:		reviewed by:
telephone:		approved by:
contract number:	please check: expenses are accrual cash please check: expenses are accrual cash
contract period:	period reported: quarter reported: 1st 2nd 3rd 4th final 1st 2nd 3rd 4th final
items of expenditure	approved budget	contract expenses this quarter	cumulative contract expenses
salaries	$	$	$
fringe benefits	$	$	$
general operating	$	$	$
indirect costs	$	$	$
equipment	$	$	$
purchased services	$	$	$
total gross expenses	$	$	$
less revenue
net operating expenses	$	$	$
# of students served	$	$	$
cost per student	$	$	$

STATEMENT OF CERTIFICATION: I hereby certify that the information contained herein is valid and accurate to the best of my knowledge.

Signature of Executive Director or person of comparable authority:

_______________________________________________ Date: ______________________________