APPENDIX “E”

BUDGET FORM

Annual Universal Pre-Kindergarten Operating Budget

Please print your agency’s name at the bottom of every page

(If you are currently a Cuyahoga County UPK Provider, please DO NOT include funding received from the UPK Program).

INCOME

Sources of Income / Total
Parent Fees (for preschool children only)
(# of children x $ amount/week x # of weeks) / $
Fundraising and/or Donations / $
Head Start / $
Vouchers (for preschool children only) / $
USDA (for preschool children only) / $
United Way / $
Total Income / $
SUTQ Quality Achievement Award / $
INCOME GRAND TOTAL / $
INCOME NARRATIVE

INCOME BREAK-OUT CHARTS

Please complete the following charts and make sure the sum total of all funding sources listed on these charts agrees with the amount on the Income page. Only count each child once between Chart 1 and Chart 2. Count all children receiving USDA in Chart 3. Do not include UPK funding.

Total number of preschool age (3 years through 5 years but not in Kindergarten) you plan to serve: ______

CHART 1: For Vouchers, Parent Co-Pays, Head Start, Private Pays
A / B / C / D / E / F / G
Funding Sources / Part-time
or
Full-time / Daily Rate / Number
of Days to
be Served / Number
of Children
to be Served / Total
(C x D x E) / Explanation of
Full Time or Part Time
Parent Fees / $
Parent Fees / $
Parent Co-Pay / $
Voucher / $
Head Start / $
Total / $

INCOME BREAK-OUT CHARTS - Continued

CHART 2: For Children Receiving Both Head Start and Voucher Funding ONLY
A / B / C / D / E / F / G
Funding Sources / Part-time
or
Full-time / Daily Rate / Number
of Days to
be Served / Number
of Children
to be Served / Total
(C x D x E) / Explanation of
Full Time or Part Time
Head Start / $
Voucher / $
Total / $
CHART 3: USDA Funding ONLY
A / B / C / D / E / F / G
Funding Sources / Part-time
or
Full-time / Daily Rate / Number
of Days to
be Served / Number
of Children
to be Served / Total
(C x D x E) / Explanation of
Full Time or Part Time
USDA / $
USDA / $
USDA / $
Total / $

EXAMPLES OF COMPLETED INCOME BREAK-OUT CHARTS

CHART 1: For Vouchers, Parent Co-Pays, Head Start, Private Pays
A / B / C / D / E / F / G
Funding Sources / Part-time
or
Full-time / Daily Rate / Number
of Days to
be Served / Number
of Children
to be Served / Total
(C x D x E) / Explanation of
Full Time or Part Time
Parent Fees / PT / $15.00 / 200 / 10 / $30,000 / 4 days wk/3hrs day
Parent Fees / PT / $15.00 / 148 / 10 / $22,000 / 3 days wk/3hrs day
Parent Co-Pay / $10,000
Voucher / FT / $27.00 / 252 / 60 / $408,240 / 5 days wk/5hrs day or more
Head Start / PT / $30.00 / 140 / 10 / $42,000 / 4 days wk/3hrs day
Total / 90 / $512,240
CHART 2: For Children Receiving Both Head Start and Voucher Funding ONLY
A / B / C / D / E / F / G
Funding Sources / Part-time
or
Full-time / Daily Rate / Number
of Days to
be Served / Number
of Children
to be Served / Total
(C x D x E) / Explanation of
Full Time or Part Time
Head Start / PT / $30.00 / 140 / 20 / $84,000 / 4 days wk/3hrs day
Voucher / FT / $27.00 / 252 / 20 / $136,080 / 5 days wk/5hrs day or more
Total / 40 / $220,080

EXAMPLES OF COMPLETED INCOME BREAK-OUT CHARTS - Continued

CHART 3: USDA Funding ONLY
A / B / C / D / E / F / G
Funding Sources / Part-time
or
Full-time / Daily Rate / Number
of Days to
be Served / Number
of Children
to be Served / Total
(C x D x E) / Explanation of
Full Time or Part Time
USDA / PT / $2.00 / 200 / 10 / $4,000
USDA / PT / $2.00 / 148 / 10 / $2,960
USDA / PT / $2.00 / 140 / 10 / $2,800
USDA / FT / $3.00 / 252 / 80 / $60,480
Total / 110 / $70,240

EXPENSES

Program Expenses / Total
Personnel / $
Occupancy / $
Equipment / $
Food / $
Supplies / $
Other Operating Expenses / $
EXPENSES GRAND TOTAL / $
EXPENSES NARRATIVE

EXPENSE BREAK OUT CHARTS

Please complete the following charts and make sure the sum total of all expense categories agrees with the amount on the Expense Summary Page. Do not include UPK Expenses.

Personnel / % Of Time1 / Annual Salary / Total
Director / Type B Provider / $ / $
Head Teacher / $ / $
Teacher 1 / $ / $
Teacher 2 / $ / $
Aide 1 / $ / $
Aide 2 / $ / $
Cook / $ / $
Custodian / $ / $
Other Personnel
(ex. Accountant, Secretary, etc.) / $ / $
Fringe Benefits (@ ______%) / $ / $
Substitutes
(@ hourly wage x # of weeks) / $ / $
PERSONNEL TOTAL / $ / $

% Of Time1 : If full time list 100%. If part time give the percentage.

PERSONNEL NARRATIVE

EXPENSE BREAK-OUT CHARTS - CONTINUED

Occupancy / Total
Rent (@ $______month x 12 months) / $
Electricity / $
Telephone / $
Insurance / $
OCCUPANCY TOTAL / $
Equipment / Total
Educational / $
Kitchen / $
Housekeeping / $
Office / $
EQUIPMENT TOTAL / $
Food / Total
2 meals & 1 snack or 1 meal & 2 snacks (if applicable)
($ amount x number of preschool children x number of days) / $
FOOD TOTAL / $
Supplies / Total
Educational / $
Housekeeping / $
Office / $
SUPPLIES TOTAL / $

EXPENSE BREAK-OUT CHARTS - CONTINUED

OCCUPANCY, EQUIPMENT, FOOD & SUPPLIES NARRATIVE (please use a separate page if necessary)
Other Operating Expenses / Total
Advertising / $
Licensing Fees / $
Indirect Costs (ex. Legal fees, technology support,
maintenance fees, etc). / $
Other (please list each one separately) / $
$
$
OTHER OPERATING EXPENSES TOTAL / $
OTHER OPERATING EXPENSES NARRATIVE

ADDITIONAL UPK-RELATED EXPENSES

Please describe what additional expenses you expect your program will incur in order to fully implement the Universal Pre-Kindergarten requirements or to continue the program.

Personnel
Description & Rationale / Cost
Increased Staff Salaries:
$
Increased Fringe Benefit Package:
$
Increased Staff Training and Professional Development:
$
Additional Personnel Expenses Total / $

ADDITIONAL UPK-RELATED EXPENSES – CONTINUED

Please list each expense category and describe what additional expenses you expect your program will incur in order to fully implement the Universal Pre-Kindergarten requirements or to continue the program.

Additional Classroom Equipment / Supplies
Description & Rationale / Cost
$
$
$
$
Additional Classroom Expenses Total / $

ADDITIONAL UPK-RELATED EXPENSES – CONTINUED

Please list each expense category and describe what additional expenses you expect your program will incur in order to fully implement the Universal Pre-Kindergarten requirements or to continue the program.

Other Additional Expenses
Description & Rationale / Cost
Example: Transportation (for half day programs only)
$
$
$
$
Other Additional Expenses Total / $
ADDITIONAL UPK-RELATED EXPENSES
GRAND TOTAL / $

Please make sure the sum total of all Additional UPK-Related Expense Categories agrees with the Additional UPK-Related Expenses Grand Total.