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Sample Fund Expenditures Form

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SAMPLE
ASHRAE UNDERGRADUATE PROGRAM EQUIPMENT GRANT
FUND EXPENDITURES FORM

School:

Project Title:

ASHRAE UNIVERSITY

Build Refrigeration Cycle Demonstrator for Use in Engineering Lab

Item

(1) 1/6 HP Compressor

Pyrex Pipe and Fittings

Flanges and O-Rings

Valves

Mounting Stand

Nuts, Bolts, Hardware

Refrigerant 123 Charge

Duplication & postage

Miscellaneous

Budget

$150.00

$350.00

$100.00

$125.00

$100.00

$50.00

$90.00

$25.00

$10.00

----------------------

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Total

$1,000.00

CERTIFIED BY:

John Doe, Ph.D., P.E.

DATE: 12/1//06

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