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DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC 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: _General Operating Expenses <br /> Cost Elements Cost( ) Quantity/Unit of measure Subtotal( ) <br /> Rent $675 12 $8100 <br /> Insurance $1000 2 policies $2000 <br /> Utilities $100 12 months $1200 <br /> Licensing and programming fees $1367 1 year $1380 <br /> Advertising $224 10 ads in Indy $2240 <br /> Compensation $77 12 months $925 <br /> Office Supplies $58.33 12 months $700 <br /> Bank and PayPal Fees $125 1 year $125 <br /> Taxes $350 1 year $350 <br /> Postage $75 1 year $75 <br /> Dues $908 1 year $908 <br /> Total $18003 <br /> c.) Cost per Unit <br /> Actual 2014-15 Estimated 2015-16 Projected 2016-17 <br /> Total Cost of Program $15843.00 $18003.00 $16,550.00 <br /> Total # of Units 2190 2196 2190 <br /> Cost Per Unit $7.23 $8.20 $7.56 <br /> Main Application 5/25/2016 10:00:47 AM P 16 of 20 <br />