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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 /> b.) Program Budget Detail <br /> What is the cost to deliver your project/program? List each project/program element in the table below, <br /> including the cost of each element, the quantity and unit of measure, and the subtotal for each element. <br /> Where necessary, allocate costs to the use of shared space, vehicles or equipment. <br /> Example Program: Credit Counseling Class <br /> Cost Elements Cost($) Quantity/Unit of Measure Subtotal ($) <br /> Credit Counseling Teacher–in class $25 96 hours (8 hrs/mth x 12 months) $2,400 <br /> Credit Counseling Teacher—class prep $25 48 hours (4hrs/mth x 12 mths) $1,200 <br /> Credit Counselor—one-on-one $20 120 hours (10 hrs/mth x12 mths $2,400 <br /> Materials $25 120 course packets/credit reports $3,000 <br /> Total $9,000 <br /> Complete the table below for the project/program for which you are requesting funds. <br /> Attach additional rows/pages, as needed. <br /> Program: <br /> Cost Elements Cost( ) Qua rtity/Unit of measure Subtotal(S) <br /> Compensation $8,153.7 mo $8,153.75 staff/admin. support $97,845 <br /> Materials $216 $216 mo. X 12 2,600 <br /> Rent and Utilities $1449 $1449.58 x12 months 17,395 <br /> Travel and Training $933 $933 x 12 mo local travel and tng 11,200 <br /> Other $2256.33 mo. X 12 (see below) 27,076 <br /> Top Three-indirect Indirect=8,806, computer=$5,000 <br /> Occupancy Occupancy$5,030 <br /> Computer Maintenance Total $156,116 <br /> C.) Cost per Unit <br /> Actual 2014-15 Estimated 2015-16 Projected 2016-17 <br /> Total Cost of Program $206,034 $156,116 $156,116 <br /> Total # of Units 254 250 212 <br /> Cost Per Unit $824.14 $690.80 $736.40 <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 5/25/2016 9:13:32 AM OI:° ag 21 of 23 <br />