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DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 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: Volunteers for Youth, Inc. <br /> Cost Elements Cost( ) Quantity/Unit of measure Subtotal( ) <br /> Mentor coordination $100/month 65 youth participants $78,000 <br /> Community service coordination $90/month 110 youth participants $118,800 <br /> Teen court coordination $100/month 55 youth participants $66,000 <br /> Total $262,000 <br /> C.) Cost per Unit <br /> Actual 2014-15 Estimated 2015-16 Projected 2016-17 <br /> Total Cost of Program $261,029 $255,000 $262,648 <br /> Total # of Units 210 215 230 <br /> Cost Per Unit $1,243 $1,186 $1,142 <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 10:34:40 AM OI:° ag 23 of 25 <br />