Tobacco Purchase Justification Form	PURCH-333 10-29-03
County Extension Agent	County
Family Program Assistant	Date
1.	Please provide a justification for how the nutrition education materials/food demonstration supplies purchased are to be used to support tobacco programming.
2.	If the purchase is for food demonstration materials and supplies, list the recipe(s) being demonstrated and the curriculum or source of the recipe(s). (Please attach a copy of the recipe if the recipe is not from an approved source.)
3.	List the lesson(s) the purchased items support.
4.	Indicate the number of participants attending the programs for which items were purchased:
Total # of Participants	(Include a copy of the sign-up sheet)
Total Cost
Program Assistant – Tobacco Grant	Date
IMPORTANT: In order for Tobacco Grant purchases to be approved, this purchase justification form must be attached to all purchases charged to the Tobacco Grant project including: PURCH-304: Purchase Request; PURCH-330: Request for Reimbursement; and PURCH-307: Authorization to Pay Under Blanket Order.