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DocuSign Envelope ID: D2CB2439-4B3B-42E7-A090-286FDDD6E948 t A - continued <br /> Provider's Outside Agency Application <br /> 4. FINANCIAL INFORMATION FOR SERVICE PROGRAMS <br /> a.) Program Budget <br /> Please complete a Program Budget Excel Form for each requested program. The <br /> Program Budget should reflect only figures and amounts associated with the <br /> Program(s) for which you are seeking funding and not the total agency budget. <br /> If the program's finances experienced significant changes that you would like to explain, <br /> please use the space below. <br /> It is required that your Excel budget worksheet be embedded on the next page. You <br /> must also submit an electronic copy of the MS Excel file with your application, as a <br /> separate file. <br /> We regret we are unable to embed Excel budget files into this Word Document. <br /> As a result the Excel files will be submitted as attachments <br /> b.) Program Budget Detail <br /> What is the cost to deliver your project/program? List each project/program element in the table <br /> below, including the cost of each element, the quantity and unit of measure, and the subtotal for <br /> each element. Where necessary, allocate costs to the use of shared space, vehicles or <br /> 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 <br /> requesting funds. Attach additional rows/pages, as needed. <br />