Contract Form (Procedure 5.0900)



Submitted by:___________ Date:_____________

Cost Center Title:_________________ Cost Center Number:___________

Section I--Identifying Information

1. Who is the Contract/Grant with: ___________

Duration of the Contract/Grant: ____________

Purpose of the Contract/Grant: ____________

2. Projected Revenue and Expenditures

A. Projected Enrollment

Fundable _________ Non-Fundable _____________N/A ___________


B. Revenue

Fees (in accordance with current fee schedule) $__________

Negotiated Fee (must be full cost) $__________

Other Revenue $ __________

Total $ =========

C. Projected Expenses: By category

Salaries $ __________

Supplies and Expense $___________

Capital Outlay $___________

Indirect Cost Recovery $________ _

Total $==========


3. Facilities Use: Will this contract require the commitment of College facilities?

YES________ NO_________ If Yes, what facilities will be needed?___________


Section II--Reviews


Cost Center Chair Signature/Date _______________________________o Yes o No

Director/Dean Signature/Date _________________________________ o Yes o No

Vice President Signature/Date _________________________________ o Yes o No