An increase in Chlamydia infections among teens in the community
Budget Worksheet
Directions: Complete the budget worksheet with an accounting of the types of costs associated with the implementation of your health education program. For example, if you are doing field work, will you require the purchase of a laptop, or of external data drives to store your data collection? Use realistic monetary totals for each respective criterion that you will need in the implementation of your health education program.
Note: Not all line items will be relevant to every health education program and you are to complete this worksheet with a maximum budget of $100,000.00 dollars as a cap for your health education program.
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Health Education Program: |
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Start-Up Costs |
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Subtotal |
Total |
Capital Costs |
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Purchase of Land |
acres @ $ /acre |
$ |
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Facility Construction |
sq. ft. @ $ /sq. ft. |
$ |
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Facility Renovation |
sq. ft. @ $ /sq. ft. |
$ |
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Equipment (capital): |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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Total Equipment |
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$ |
Other Start-Up Costs |
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Facility Design |
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$ |
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Furnishings: |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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Total Furnishings |
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$ |
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Needs Assessment |
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$ |
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Marketing Analysis |
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$ |
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Legal Assistance |
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$ |
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Licenses/Permits |
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$ |
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Materials Development |
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$ |
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Staff Training |
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$ |
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Other: |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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Total Other |
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$ |
Operating Costs |
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Subtotal |
Total |
Staff Salaries and Wages: |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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Total Staff Salaries and Wages |
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$ |
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Fringe Benefits |
% x Salaries & Wages |
$ |
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Consultants/External Contractors: |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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Total Consultants/External Contractors |
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$ |
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Facilities: |
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Facilities Leasing |
$ |
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Utilities |
$ |
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Facilities Maintenance |
$ |
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Total Facilities |
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$ |
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Non-Capital Equipment — Purchased: |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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Total Non-Capital Equipment — Purchased |
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$ |
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Non-Capital Equipment — Rental: |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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Total Non-Capital Equipment — Rental |
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$ |
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Equipment Maintenance |
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$ |
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Subtotal |
Total |
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Office Supplies |
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$ |
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Other Supplies |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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Total Other Supplies |
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$ |
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Communications (telephone, e-mail, website, etc.) |
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$ |
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Printing/Copying |
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$ |
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Advertising/Promotion |
|
$ |
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Program Materials/Resources |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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Total Program Materials/Resources |
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$ |
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Transportation |
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$ |
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Travel |
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$ |
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Staff Training/Development |
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$ |
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Other: |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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Total Other |
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$ |
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Subtotal $ |
Total $ |
TOTAL COST (Start-Up + Operating) |
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$ |
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INCOME: |
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Income Sources: |
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1. |
$ |
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2. |
$ |
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3. |
$ |
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4. |
$ |
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5. |
$ |
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TOTAL INCOME |
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$ |
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