In Kind Contribution Form

The Drug Free Communities Support Program requires the coalition to provide matching funds. This is accomplished primarily through in-kind contributions. In-kind contributions can be such things as a person’s time, a service (with a price assessed), supplies, meeting space, technology costs, etc. This form is designed to capture your in-kind donations to the coalition. If you have any questions, feel free to contact Jodie Faber at coordinator@montcalmprevention.org.

In recording your time, please round to the nearest quarter hour.
Your Name Your Name First Last
Phone Phone - ### - ### ####
Your Email
TIME DONATION

**Time preparing for an activity includes but is not limited to printing and reading the agenda, minutes, emails, etc.; gathering supplies or materials; preparing a presentation, reviewing information related to an activity, etc.
Date of Contribution Date of Contribution / MM / DD YYYY
Date Range of Contribution (if your submission covers a range of time vs. a specific date. Example: May 1 - October 30)
Name of Event/Contribution/Service, etc.:
Total Miles Driven (Round Trip):

If you drove, please list total miles driven roundtrip here.
Travel Time

Time for traveling, whether you drove or not
In-Kind Time: (Record in 1/4 hour increments. No text, only numbers.)

Please enter only in 1/4 hour increments. IE: 1.5 for 1 1/2 hours. .75 for 45 minutes etc. Do not enter text - only numbers. This includes preparing, set-up, take-down, etc.
RESOURCE DONATION

Examples include: meeting space, technology, phone conferencing equipment, other equipment, materials, a service with a price assessed, etc.
Total Hours in Meeting Space at MMDHD/MAISD/Other Location
Dollar Value:
Total Time:
Total Hours Use of Conference Calling Technology
Dollar Value:
Total Time:
Other resource donation (if any):
Other resource donation (if any):
MEDIA

Coverage/Impressions/Engagement Examples include: Newspapers, Radio, Television, Facebook, Twitter, Snapchat, Flyers, Community Events, Presentations, Trainings sponsored by MPC, Collaborative Efforts with MPC.
Our media coverage is an important measurement of our coalitions reach, impressions, and engagement in the community.
• Reach: the number of people who see your content.
• Impressions: the number of times your content is displayed.
• Engagement: the number of interactions people have with your content (i.e.: likes, comments, shares, retweets, etc.)
Date of Media Date of Media / MM / DD YYYY
Media Coverage/Impression/Engagement:
Reach:
Time Developing Media Activity:
Thank You For Your In-Kind Contribution!

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In Kind Contribution Form

In Kind Contribution Form

In recording your time, please round to the nearest quarter hour.

TIME DONATION **Time preparing for an activity includes but is not limited to printing and reading the agenda, minutes, emails, etc.; gathering supplies or materials; preparing a presentation, reviewing information related to an activity, etc.

RESOURCE DONATION Examples include: meeting space, technology, phone conferencing equipment, other equipment, materials, a service with a price assessed, etc.

MEDIA Coverage/Impressions/Engagement Examples include: Newspapers, Radio, Television, Facebook, Twitter, Snapchat, Flyers, Community Events, Presentations, Trainings sponsored by MPC, Collaborative Efforts with MPC.

Thank You For Your In-Kind Contribution!

TIME DONATION

**Time preparing for an activity includes but is not limited to printing and reading the agenda, minutes, emails, etc.; gathering supplies or materials; preparing a presentation, reviewing information related to an activity, etc.

RESOURCE DONATION

Examples include: meeting space, technology, phone conferencing equipment, other equipment, materials, a service with a price assessed, etc.

MEDIA

Coverage/Impressions/Engagement Examples include: Newspapers, Radio, Television, Facebook, Twitter, Snapchat, Flyers, Community Events, Presentations, Trainings sponsored by MPC, Collaborative Efforts with MPC.