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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 Adapted Sports Day <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change <br /> Private Donations 0 <br /> Agency Generated Revenue(fees) $ - 0 <br /> Local Government Grants: <br /> Orange County $ 5,000 0 <br /> To of Chapel Hill $ 5,000 0 <br /> To of Carrboro $ 5,000 0 <br /> Other Local: Durham County 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 0 <br /> Please list 3 largest Miscellanous sources: <br /> Total Agency Revenue $ - $ - $ 15 000 0 <br /> AGENCY EXPENSES <br /> Compensation $ 8,100 0 <br /> Rent&Utilities 0 <br /> Supplies&Equipment $ 6,600 0 <br /> Travel&Training $ 300 0 <br /> Other Expenses: 0 <br /> Please list 3 largest"Other Expenses": <br /> Total Agency Expenses $ - $ - $ 15,000 0 <br /> SURPLUS/(DEFICIT) FOR PERIOD: I $ - I $ - I $ - I 0+ <br /> Main Application 5/24/2016 9:03:13 AM .. ag 23 of 2 <br />