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DocuSign Envelope ID: 112713E4-A11E-4CO3-B5A6-92020A894CD7 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Please include program staff positions followed by volunteer positions; these financial figures <br /> should match the personnel figures in your Agency Comparative Budget Excel Form. Similar <br /> positions can be combined. (i.e., 8 Occupational Therapists can be inserted as one line item). <br /> If provided, <br /> indicate: <br /> Position Titles FTE* Progra Actual Estimate Projected Total Retirement <br /> *= Position Vacant * m Staff 2014-15 d 2015-16 2016-17 Budge Plan <br /> + t (H) Health <br /> Plan <br /> Occupational Training <br /> Specialists* (entire 1,064,07 1,069,39 <br /> agency) 45 50% 1,058,781 5 5 20% (H) <br /> Employment Service <br /> Lead 4 50% 201,443 202,451 203,463 4% (H) <br /> Program Service <br /> Lead 6 50% 164,802 165,626 166,454 3% (H) <br /> Case Support <br /> Specialist 4 50% 65,834 66,163 66,494 1% (H) <br /> Business Relations <br /> Representative 1 50% 44,094 44,314 44,536 1% (H) <br /> Project Manager 2 50% 109,041 109,586 110,134 2% (H) <br /> Job Development <br /> Specialist 8 21% 199,141 200,137 201,138 4% (H) <br /> Senior Management 7 17% 635,268 638,444 641,637 12% (H) <br /> Job Retention <br /> Coordinator 2 0% 42,760 42,974 43,189 1% (H) <br /> Federal Contract 1,959,49 1,969,29 <br /> Employees 72 0% 1,949,743 2 0 37% (H) <br /> Administrative Staff 8 0% 187,727 188,665 189,609 4% (H) <br /> Production Staff 47 0% 635,268 638,444 641,637 12% (H) <br /> Notes: <br /> • Similar positions can be combined: i.e. 8 Occupational Therapists can be inserted as one line item. <br /> • ** Full Time Equivalent staff will be noted as 1.00; half time as .50; quarter time as .25, etc. <br /> • + Denotes the percentage of staff time involved with this program. <br /> • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: <br /> Total Volunteer Hours =Volunteer FTE <br /> 1,960 <br /> Main Application 2/1/2016 11:26:11 AM 4:) c 11 of 1 <br />