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DocuSign Envelope ID:6CD4A528-52AE-410E-B18B-BA619068A9AB 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: MEDIATION <br /> Cost Elements Cost( ) Quantity/Unit of measure Subtotal( ) <br /> Personnel costs (90% of budget) $ 95,070 Staff time allocated to program 95,070 <br /> Travel $ 1,800 To courthouse and back, etc. 1,800 <br /> Supplies and support incl space, telecom, $ 13,130 13,130 <br /> And Equip, printing, insurance, auditing <br /> Total 110,000 <br /> C.) Cost per Unit <br /> Actual 2014-15 Estimated 2015-16 Projected 2016-17 <br /> Total Cost of Program 104,462 107,375 110,000 <br /> Total # of Units 639 660 650 <br /> Cost Per Unit 163.47 162.60 169.23 <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 9:47:14 AM P 20 of 2 <br />