3-Project Budget and Funding Sources Worksheet.docx

This is a Project Budget and Funding Sources Worksheet template issued by the Aging and Long Term Services Department (ALTSD) in New Mexico for senior centers applying for capital outlay funding. The worksheet is designed to accompany capital outlay applications for equipment and furnishings that support senior center programming, including congregate meal preparation equipment, health and fitness equipment, wellness equipment, senior center furnishings such as tables and chairs, and recreation and activity equipment such as billiard tables and game tables. Applicants must complete one worksheet per project and provide a project title, fiscal year, amount requested, total project cost, and project manager contact information. The form requires alignment between budget amounts and project scope with supporting documentation including quotes and estimates.

The worksheet captures detailed budget information across multiple line items, with columns for capital outlay requests and other funding sources. Applicants must identify all funding sources and amounts, including local government or fiscal agent funds, tribal funds, state funds, federal funds, grants or donor funds, and other sources, along with their status as either secured or pending. The form requires certification that total funding equals total project budget, with sections to document any remaining funding gaps, costs not included, and the fiscal agent fund or appropriation source used to pay allowable costs before reimbursement. An authorized representative must sign and date the certification, confirming the budget is complete, accurate, aligns with quotes and estimates, and identifies all known funding sources necessary to complete the project.