HC - Programmatic and Budget Modification Request Form

HC - Programmatic and Budget Modification Request Form
This form is a mechanism for subgrantees to request modifications to approved projects and budgets.

JFNA approved form completion and submission is required before making changes to the project goals, objectives, or activities, or expenditure amounts on the approved budget by more than 25% on any line item. If the change is less than $1,000, this form is not required. If there is a change that affects the budget, please upload the Budget Modification Template.
I. Background Information
Full Agency Name
JFNA Grant Number
Address

Street Address

Street Address Line 2

City State
Contact Name

First Name Last Name
Phone Number

Area Code Phone Number
Email Address
example@example.com
II. Proposed Programmatic Modification(s): Describe proposed changes to your project goal(s), objective(s), or activities, detailing any implications on staffing, programming, and the number of beneficiaries. Include any new information learned.
III. Proposed Budget Change(s): If the proposed programmatic changes affect the approved budget, please explain the changes in a narrative format.
IV. Budget Modification Request Form: If the proposed programmatic changes affect the approved budget, please complete a Budget Modification Template. Highlight in yellow all rows that are proposed to change. Please use the approved award budget format as a guide.
Upload Budget Modification Template here:

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