Fillable IK-3 Sample External Matching Certification Form

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IK-3 Sample External Matching Certification Form

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IK-3 03/09/18
Internal In-Kind Matching Summary Form
Project Name: ____________________________________________________________________________
Index No.: ____________ Principal Investigator: ______________________________________________
Project Period: __________________ Department:______________________________________________
Funding Agency: __________________________________________________________________________
Report Period for Matching Cost Items Noted Below: _____________________________________________
Reminder: Proper documentation must be maintained for all items noted as "in-kind” match as they are subject to federal
audit. The dollar value of these non-cash donations should be calculated at their verifiable fair-market value.
Actual Cost Sharing
Source of Match
(external sponsor)
Category*
This
Reporting
Period**
Project
To Date
Cost Sharing
Budget Balance
TOTAL COST SHARING
*Category includes salaries, fringe benefits, travel, meetings/conference, publications, printing, supplies, equipment or
equipment usage, equipment maintenance, other (must specify).
**The date of the activity or purchase order must be within the project period.
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IK-3 Sample External Matching Certification Form

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Completed 11 March 2020

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