FY21_RCDG_Applicant_In_Kind Match_Verification_Template.docx

RCDG

Verification of Applicant IN-KIND Contribution

For purposes of carrying out the Work Plan and Budget Activities identified in our FY 2021 Rural Cooperative Development Grant (RCDG) Program application, I verify the following information:

Legal Name of Applicant:

Beginning and End Dates for Proposed Grant Period:

Total Project Costs: $ Total Applicant In-Kind Value: $ In the chart below for Applicant In-Kind Contributions, describe (a) the nature of the goods and/or services to be donated to the RCDG project during the proposed grant period and how they will be used, (b) when the goods and/or services will be donated during the proposed grant period, and (c) the value of the goods and/or services.

Total Value

|_| Our governing body (i.e., Board of Directors or Tribal Council) has formally Resolved / Confirmed the Cash Matching contribution amount for RCDG purposes on .

|_| I/We do not need a Resolution because it is not required by our governing body for us to authorize the Cash Matching contribution amount described above.

Print Name of Authorized Representative:

Signature of Authorized Representative: _____________________________________ Date:

Title of Authorized Representative:

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