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DocuSign Envelope ID: 1007B77C-A009-4AA3-964B-3B03B9585341 <br /> txnibit A-continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Program Budget <br /> Agency/Program Bridge II Sports: Wheelchair Basketball <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change <br /> Private Donations $ 14,592 $ 36,241 $ 30,265 -16% <br /> Agency Generated Revenue(fees) $ - $ 2,100 $ 4,500 114% <br /> Local Government Grants: <br /> Orange County $ 1,250 $ 1,250 $ 1,500 20% <br /> To of Chapel Hill $ 750 $ 750 $ 1,500 100% <br /> Town of Carrboro $ 2,500 $ 1,750 $ 1,500 -14% <br /> Other Local: Durham County $ 3,000 $ 3,000 $ 3,000 0% <br /> Other Local: 0 <br /> Other Local: 0 <br /> If more than 3 sources,please <br /> provide a separate list. <br /> Non-Local Government Grants <br /> Triangle United Way 0 <br /> State Government 0 <br /> Federal Government 0 <br /> Other Grants: 0 <br /> Other Grants: 0 <br /> Miscellaneous/Other Revenue $ 2,000 $ 1,500 $ 4,500 200% <br /> Please list 3 largest Miscellanous sources: <br /> Team Fundraising $ 4,500.00 <br /> $ - <br /> Total Agency Revenue $ 24 092 $ 46 591 $ 46 765 0% <br /> AGENCY EXPENSES <br /> Compensation $ 5,250 $ 8,800 $ 8,800 0% <br /> Rent&Utilities $ 3,342 $ 8,994 $ 8,994 0% <br /> Supplies&Equipment $ 15,000 $ 28,197 $ 28,197 0% <br /> Travel&Training $ 500 $ 600 $ 774 29% <br /> Other Expenses: 0 <br /> Please list 3 largest"Other Expenses": <br /> Total Agency Expenses $ 24,092 $ 46,591 $ 46,765 0% <br /> SURPLUS/(DEFICIT) FOR PERIOD: I $ - I $ - I $ - I 0+ <br /> Main Application 5/24/2016 9:03:13 AM Pa 21 of 2 <br />