AAMU – Title III Strengthening Grants Program Form 6 – Updated 10-1-14
CONSULTANT REPORT FORM
This form must be completed by the consultant and attached to the request for reimbursement.
Person and Department requesting consultant: ______________________________________________
Consultant’s Name: ____________________________________________________________________
Address: _______________________________________________________________________
_______________________________________________________________________
__________________________________________ _____________________________________
Title Institution/Organization/Agency
Date(s) of Service: __________________________ Total # of hours worked: ________________
Title of Program: ______________________________________________________________________
Number of Participants: ________________________________________________________________
Summary: Please attach a written report including the following information: Objectives of the program, an
overview of major topics discussed, evaluation results, a copy of the program agenda, roster, program
evaluation results and other pertinent information.
Amounts Charged to Grant:
Consulting Fee ________________
Fare – Train/Plane/Bus & Ground Transportation (Taxi Cabs) ________________
(Attach Receipts)
Auto (
current State rate) ________________
Meals (current State rate) ________________
Lodging – Actual Expenses (Attach Receipts) ________________
(Not to exceed 4 nights)
TOTAL ________________
______________________________ ______________
