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DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> c.) Cost per Unit <br /> estimated 2015- <br /> Actual 2014-15 1 Projected 2011-17 <br /> Total Cost of Program 0 $19,200 $28,800 <br /> Total # of Units 0 80 hrs./month 120 hrs./month <br /> Cost Per Unit 0 $20.00 $20.00 <br /> This Cost Per Unit must reflect the total program budget and the total number <br /> of program beneficiaries (households or persons) in this application and must <br /> be consistent with report submittals from previous years (if applicable). <br /> Agency Operating Budget <br /> Please show all sources and amounts of funding for your entire current fiscal year. What is your <br /> agency's fiscal year? Example: July 1, 2016 through June 30, 2017. Submit operating budget in <br /> your own format. <br /> Do not include funds that have been applied for but not yet awarded: If the total revenue is not <br /> the same amount as the budget for any fiscal year, please attach a statement explaining the deficit <br /> or surplus. <br /> It is required that your Excel budget worksheet be embedded on the next page. You must <br /> also submit an electronic copy of the MS Excel file with your application, as a separate file. <br /> FY16-17 <br /> OCOAG <br /> FY14-15 FY15-16 Projected <br /> Actuals Budget Budget <br /> Ordinary Income/Expense <br /> Income <br /> 4000• <br /> Contributions <br /> 4010• Individual Contributions $24,527 $10,750 $15,000 <br /> 4011 • Sponsorships $10,475 $16,950 $15,000 <br /> 4210• Corporate Grants& Donations $1,500 $1,700 $1,500 <br /> 4610• Organization/Foundation Grants $0 $0 $0 <br /> 4810• Government Grants $35,767 $34,850 $41,500 <br /> Total 4000• Contributions $72,269 $64,250 $73,500 <br /> Main Application 1/22/2016 8:56:04 AM Pago 21 of 2 <br />