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Please submit only information for the program seeking funding. If there is more than <br />one program for which you are requesting funding, submit forms for each. • <br />Section H. <br />A. Program Data: <br />Agency <br />SERVICE STATISTICS <br />Define one unit of service: <br />Program <br />Units of Service Total Program Cost Unit Cost <br />Units of service actual (08/09) <br />Total cost of this service (08/09) <br />Actual cost per unit (08/09) <br />Units of service estimated (09/10) <br />Estimated total cost (09/10) <br />Estimated cost per unit (09/10) <br />Units of service proposed (10/11) <br />Proposed total cost (10/11) <br />Proposed cost per unit (10/11) <br />Revised May 25, 2010 <br />4 <br />• <br />• <br />