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D to the (grant) during the month of , 20 , and that the services were performed according to appropriate grant policies as set forth in the grant application and award documents. Grant: Employee Name: Month/Year: Position Title: Percentage of Time devoted to the grant: Date Major Work Performed: Descriptive Task(s) Hours Worked/ % Time Please use the additional pages as needed. Employee Signature: Total Hours: Director Signature: One copy to be retained b.

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