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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: Ada•ted S•orts Da Public Schools <br /> Cost Elements Cost($) Quantity/Unit of measure Subtotal ($) <br /> Program Staff $30 2 Staff x 9 hours x 15 schools $8,100 <br /> Equipment $10 11 equip. x$15 x 8hr x 15sch $6,600 <br /> Travel $20 $20 mileage x 15 schools $300 <br /> Total $15,000 <br /> e.) Cost per Unit <br /> Actual 2014-15 Estimated 2015-16 Projected 2016-17 <br /> Total Cost of Program $15,000 <br /> Total # of Units 15,000 <br /> Cost Per Unit $1 <br /> This Cost Per Unit must reflect the total program budget and the total number of <br /> program beneficiaries (households or persons) in this application and must be <br /> consistent with report submittals from previous years (if applicable). <br /> Main Application 5/24/2016 9:03:13 AM 26 of 2 <br />