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DocuSign Envelope ID: ED6C5D54-7108-4169-9541-C2FDA3EC8CA6 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: <br /> Cost Elements Cost( ) Qua rtity/Unit of measure Subtotal(S.) <br /> %2 Time Program Director 12,000 12,000 <br /> 1/2 Time Administrative/Booking Support 12,000 12,000 <br /> Program Supplies (Paper, pens, meeting 1,750 1,750 <br /> supplies, etc) <br /> Printing brochures, flyers, program badges 1,000 1,000 <br /> Company Insurance 2,200 2,200 <br /> Postage : brochure/flyer mailings 300 300 <br /> Travel to and from meetings; Seminars 750 750 <br /> Total 30,000 <br /> C.) Cost per Unit <br /> Actual 2 014-15 Estimated 2015-16 Projected 2016-17 <br /> Total Cost of Program <br /> Total # of Units <br /> Cost Per Unit <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 5/25/2016 9:25:11 AM .. of 20 <br />