School 21st Century CLC STEEAAM INVOICE - Year 1 For Funding Source:
ASB
BSB
X
ASP
Date Preparer Site Coordinator School Phone
BSP
DA
Billing Period Prep. Email SC Email School Fax
Attach Detailed Description of Services Performed: (insert rows after row 1 to add additional lines as necessary) OC 1000 (Certificated Salaries)
# of Hrs
1 Academic Liasion 2 3 4 5 SUBTOTAL 1000 OC 2000 (Classified Salaries)
# of Hrs or Time
1 SC 2 3 4 5 6 7 8 9 SUBTOTAL 2000 OC 4000 (Books & Supplies)
Rate P/H or Mo
Sub Total
Object Code 3000 (Benefits) Amount Paid
$300.00
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0.00
Sub Total
Object Code 3000 (Benefits) Amount Paid
% Rate P/H or Mo. Salary
$3,333.33 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 SUBTOTAL 3000
Purpose
Date
$ $ $ $ $ $ $ $ $ $ $
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 -
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Payment
Description
Total Payment
$0.00 # of Hrs
Rate P/H
# Served
1 2 3 4 SUBTOTAL 5000 SUBTOTAL 1000-5000 OC 7000 (Administration)
Total Payment
Description of Items Purchased
1 2 3 4 5 SUBTOTAL 4000 OC 5000 (Services & Operating Costs)
Total Payment
Description of Services Provided
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Payment
1 School Administration Costs TOTAL INVOICE AMOUNT
$0.00 $0.00
I certify that the included expenditures comply with the 21st Century CLC, CDE, and UCB grant guidelines. Signature of Community Learning Center Coordinator
Name Printed
Date:
APPROVALS I APPROVE that the services described above have been completed in a satisfactory manner and I have received all required reports. I also certify that they expenses do not exceed the approved budget amount. Preparer Signature:
Date:
Principal or Other Signature:
Date:
