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DocuSign Envelope ID:38357F45-0FD1-474F-992F-A2DODA42A3E2 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 /> Exam S le Program: Creditia,u7selingClassu, ,,,(, ormfr....v r/Tr ffir i ii,,.,Ft Kim,r,,iiin r!fiffk iri,mu,of Am 1 gi
<br /> I`''l'''s rifititirlfilltili;)110011t0'4414011/6j'1101117/0711"00 41,rir,fi A III ill 1110"Ifil'ilit th
<br /> 0,
<br /> 1 ;/4 ':ii'401:16410 trialik'2"' al )iiipq '(iirl `1F l2 ,'; 2 fi':0 I 1; 4 iiiiilit di If II)idtaild/j iididil ititi 44 i llik It it s Jidad ts4 h Ar A PA A 0/IA/ ,
<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 proiect/program for which you are requesting funds.
<br /> Attach additional rows/pages, as needed.
<br /> Program: Duke HomeCare & Hospice
<br /> ,, .1,,,,,,, §,frp 9 ,ifer,„o, rtrik,,,14 lay, ,,
<br /> Nrvitawir
<br /> 4. la .,, ,..1,-ot 4 1 1'4''' 4,' / fq i),,, ,, lo 1 i 1 g ,fA ' A i) i /I . , , .w ,
<br /> IOW,7 1 PiVi'11 4 la f f -117 '
<br /> .
<br /> /111 rrrtit"11/1121:91"/Pwl till' gi,'12 /ollablediri, 4.,ii, . ,,,„,,,,,, 3,,, ,,,,,,, ,,,,, ,, „ ,,i, ,
<br /> School Grief Group $125 session 6 $750
<br /> Staff Supervision/Training $150/6 1 $150
<br /> sessions
<br /> Mileage 24 sessions 6 $144
<br /> Camp ReLEAF— 13 students $340/Student 13 $4420
<br /> Counseling for 30 children $30/child 30 $900
<br /> Counseling for 250 Adults $30/Adult 250 $7500
<br /> Total $13,864
<br /> c.) Cost per Unit
<br /> 4 111174 ri, 4,rk ,,,,4;,,, 014); i),Iffi Toifir,4',,,, v 1 , :iii, A, A A, ,..,,J A„ , ,,, A„ , i i, ■„, ,
<br /> Total Cost of Program $11,020,478 $11,518,000 $11,8817000
<br /> Total # of Units $53,931 $57,183 $58,775
<br /> Cost Per Unit $204.34 $201,42 $20214
<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 1/25/2016 11:36:35 AM Page 14 of 1 6
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