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DocuSign Envelope ID:2164F437-BF9D-46A1-B13B-7740B02003DA 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 $9,000 <br /> Complete the table below for the project/program for which you are requesting funds. <br /> Attach additional rows/pages, as needed. <br /> Program: <br /> Cost Elements Cost($) Quantity/Unit of measure S <br /> Community Impact Program Director $15.87 After-school pgm direct service 516 hrs (12 hrs/wk 5 <br /> Community Impact Program Director $15.87 Summer session direct service-225 hrs (45hrs/wk 3 <br /> Community Impact Program Director $15.87 Planning,prep,pgm.mtgs/780hrs(15hrs/wkX52 wks 2 <br /> Community Impact Program Director $15.87 Volunteer training Comm. School outreach, etc. 2 <br /> Part time Program employee (3) $12.00 After School Program 516 hrs.(12 hrs/wk X 43 3 <br /> Part time Program Employee (2) $12.00 Summer session Program-200 hrs.(40hrs/wkX5wk 3 <br /> Employee Benefits $666.00 FICA, unemplymt,health insur., (1 staff @80% 2 <br /> Rent & utilities $385.00 Office space for employees <br /> Supplies & equipment $958.00 snacks, summer meals, supplies,ipads, equipment <br /> Travel& training $2100.00 Workshops/Program training <br /> Office supplies/mailings $2100.00 office supplies, mailings to family/commumity <br /> Professional dues $880 for Program Directors/workshops/training <br /> Corporate support $46,520 Insurance,Marketing,%CEO time, keeping <br /> Program reports/outreach/leading/students <br /> Main Application 5/24/2016 8:59:25 a5/p5 P 20 of 23 <br />