Delta State University
Time and Effort Reporting Form
Faculty/Staff Name _____________________________ Month/Year________________
Department __________________________________ Title ______________________
Please list the grant-funded program(s) that time and effort has been devoted during this
reporting month:
Title of Grant-
funded Program
Fund and
Percentage of
In-kind hours
Role/Tasks with
Percentage of Time/Effort:
For release time, use 25% for 3 credit hour release; 50% for 6 credit hour release, etc.
In-kind hours: Time contributed to a grant-funded program but not budgeted in a grant.
Role/Tasks: Title (ie, Project Director, Project Assistance, etc.)
I certify that this distribution of effort represents a reasonable estimate of the time expended
during the period covered by this report.
________________________________________________ __________________
Employee Date
_____________________________________________ __________________
Program Director or Department Head/Chair Date
Upon approval, please keep on file with the grant, and also email to Heather Miller at
. Please include Time and Effort in the subject line.