Title I, Part A HomelessReservation Itemization

Title I, Part A Homeless

Reservation Itemization

Subrecipient Name

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Region

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SSA or Independent

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If a member of an SSA, please identify the Fiscal Agent.

Activity/Strategy: BS6100 Payroll Cost

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Estimated Amount-Salary for Homeless Liaison

Estimated Amount-Other Salary (Define and Justify)

Activity/Strategy: BS6200 Prof/Contract Services

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Estimated Amount-Medical and Dental

Estimated Amount-Birth Certificates

Estimated Amount-Eyeglasses and Hearing Aids

Estimated Amount-Immunizations

Estimated Amount-Counseling Services

Estimated Amount-Outreach Services

Estimated Amount-Extended Learning

Estimated Amount-Tutoring Services

Estimated Amount-Student Fees

Other 6200 (Define and Justify)

Other- 6200 Estimated Amount

Activity/Strategy-BS6300 Supplies and Materials

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Estimated Amount- Items of Clothing

Estimated Amount-Clothing and Shoes Phys Educ.

Estimated Amount- Personal School Supplies

Other 6300 (Define and Justify)

Other- 6300 Estimated Amount

Activity/Strategy-BS6400 Other Operating Costs

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Estimated Amount- Food

Estimated Amount-Fees for AP/IB Testing

Estimated Amount- Fees for College Entrance Exams

Estimated Amount-GED Testing

Estimated Amount-Parental Involvement

Other 6400 (Define and Justify)

Other- 6400 Estimated Amount

Comments and/or Additional Information

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