Reporting to Motheread® Arizona

Match Report

Submit immediately after each adult series. AHC is required to report cost-share figures to the National Endowment for the Humanities, so we need to know the value of all goods and services your organization has supplied to your Motheread® Arizona program, including staff time (including the Training Institute), facilities, materials, etc. Also include goods and services any outside organization has contributed to your Motheread® Arizona program.

Location and Dates of Motheread® Arizona Series

Services (Includes staff time of discussion facilitators)

Describe service provided:

Hours donated @ $ (hourly rate)

Total value of services: $

Travel and Other Expenses (include expenses for Training Institutes)

Number of miles donated @ 40¢ per mile $

Food, lodging, or other contributions: $

Total value of travel and other expenses: $

Goods (books, refreshments, etc., provided by Motheread® Arizona site)

Describe goods donated:

Total value of goods: $

Other Contributions (may be book money, refreshments, incentives, etc.)

Describe donations from Community Partners:

Total value of other contributions: $

Grand Total

TOTAL VALUE OF ALL CONTRIBUTIONS: $