The Maryland Emergency Management Agency
The University of Maryland Center for Health & Homeland Security
Regional Catastrophic Preparedness Grant Program
Resource Management
Dear Sir or Madam,
Thank you for your contribution to the Maryland’s Regional Catastrophic Preparedness Grant (RCPG). As you may know, the RCPG program has a matching requirement as part of the grant award. As such, we ask that all in kind donations complete our tracking form which will allow us to help meet that match requirement. The form has spaces for the time you committed to the project, your hourly rate (an estimate is sufficient) and the total in kind donation value.All participants’ time is eligible to be counted towards the match**EXCEPT 100% Federally Funded positions**.In addition, participants not funded by RCPG money from their own states, including all private sector participants, may also include travel and other project-related expenses as part of their total in kind donation.
Please fill out the attached form and email or fax it to Matilda Channel-Ward at the University of Maryland Center for Health and Homeland Security. Please feel free to call with any questions or concerns. Again, thank you for your contribution to this project.
Sincerely,
Matilda Channel-Ward
University of Maryland
Center for Health & Homeland Security
telephone 410-706-5720
fax 410-706-0583
IN-KIND DONATION TRACKING FORM
Date:______Individual’s Name:______
Organization:______
Address:______
City:______State:______ZIP:______
Telephone Number: (___)______Fax Number: (___)______
E-mail Address: ______
Website Address: ______
Donation Type (circle one): PRODUCT SERVICE
Performance Period: Start Date:______End Date:______
Product or Service Description (Please describe in detail products or services provided):______
- HOURS OF PERFORMANCE: (for donated services only)
____ (Total Hours of Donated Service) X $____ (Estimated Hourly Rate) = $______(Total In-Kind Value)
- VALUE OF PRODUCT: (for donated products only)$______(Total Estimated In-Kind Value of Products)
The University of Maryland Center for Health & Homeland Security 500 West Baltimore Street Baltimore, Maryland 21201-1786 410-706-1014 410-706-0583(fax)