EcoAction successful recipients: In-kind contribution record form

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Refer to the Recipient's Handbook for more information.

Project #:

Project Title:

Contributing Partner:

I/we certify that the following in-kind services were provided for this project:

Recipient's Name:

Recipient's Signature:

Contributing Partner's Name:

Contributing Partner's Signature:

Type Description of Services Provided Date of Services Provided No. of Units(e.g., Number of people) Unit Cost (e.g, wage rate) Duration (e.g, No. of Hours) $ Value
 Total Value:  

  Please Note: Please ensure that each contributing partner is represented by a separate In-Kind Contribution Record.

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