Request For Grant Change
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1
2Request for Grant Change
Project Title:
Organization:
Contact Person:
Email:
Phone:
Fax:
Address:
City:
State:
Zip (include +4):
-
No cost extension. Change in ending date only. (Attach explanation.)
Request ending date be extended from
to
Budget change. For reducing the budget or moving funds between categories. This
form may not be used to increase the budget. (Attach budget change form and
justification.)
Personnel change. (Attach curriculum vitae of proposed new personnel and an
explanation for the change.)
New (proposed) personnel
Position to be changed
Present personnel
Other: Explanation for request:
Required Signatures
Program Director
Signature:
Date:
Name:
Title:
Approving Institution Official Signature
Signature:
Date:
Name:
Title:
Komen Approved by: ___________________________________________________________
Printed Name: ______________________________________Date: _____________________
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Parent category: Business