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DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued
<br /> Provider's Outside Agency Application
<br /> MAIN APPLICATION
<br /> Section III. Program Information
<br /> Program Budget Worksheet
<br /> AGENCY NAME: Chapel Hill Training-Outreach Project, Inc. (KidSCope)
<br /> Actual Estimated Projected Percent
<br /> PROGRAM REVENUE 2014-15 2015-16 2016-17 Change
<br /> Private Donations $ 13,202 $ 14,100 $ 14,100 0%
<br /> Program Generated Revenue (fees) $ 32,343 $ 28,000 $ 28,000 0%
<br /> Local Government Grants:
<br /> Orange County $ 75,000 $ 75,000 $ 75,000 0%
<br /> Town of Chapel Hill $ 4,500 $ 4,500 $ 4,500 0%
<br /> Town of Carrboro $ 2,000 $ 2,200 $ 2,200 0%
<br /> Other Local: Strowd Roses $ 5,000 -100%
<br /> Other Local: 0
<br /> Other Local: 0
<br /> provide a separate list.
<br /> Non-Local Government Grants
<br /> Triangle United Way $ 12,306 $ 4,102 $ - -100%
<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 Miscellaneous sources:
<br /> $ -
<br /> $ -
<br /> $ -
<br /> Total Program Revenue $ 139,351 $ 132,902 $ 123,800 -7%
<br /> PROGRAM EXPENSES
<br /> Compensation $ 149,366 $ 97,845 $ 97,845 0%
<br /> Rent& Utilities $ 13,783 $ 17,395 $ 17,395 0%
<br /> Supplies& Equipment $ 1,906 $ 2,600 $ 2,600 0%
<br /> Travel &Training $ 9,550 $ 11,200 $ 11,200 0%
<br /> Other Expenses: $ 31,428 $ 27,076 $ 27,076 0%
<br /> Please list 3 largest"Other Expenses":
<br /> Indirect cost to CHTOP, Inc. $ 8,806.00
<br /> Occupancy costs $ 5,030.00
<br /> Computer Maintenance $ 5,000.00
<br /> Total Program Expenses $ 206,034 $ 156,116 $ 156,116 0%
<br /> SURPLUS/(DEFICIT) FOR PERIOD: ($66,684)I ($23,214)I ($32,316)I -39°I
<br /> Main Application 5/25/2016 9:13:32 AM P g 20 of 23
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