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DocuSign Envelope ID:78F84828-4CC5-4A5B-B256-33C571A84687 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 $9,000 <br /> Complete the table below for the project/program for which you are requesting funds. <br /> Attach additional rows/pages, as needed. <br /> Program: Charles House: Daytime Eldercare Program <br /> Cost Elements Cost($) quantity/unit of measure Subtotal($) <br /> Cost elements are those included <br /> In the program budget above: Costs included in program budget <br /> Personnel Expenses <br /> Property Expenses <br /> Program Expenses <br /> Administrative Expenses <br /> Other(Depreciation) Expense <br /> Total <br /> c..) Cost per Unit: (Unit of Service defined as 1 participant service day at Charles House) <br /> Actual 2014.15 Estimated 2015.16 Projected 201647 <br /> Total Cost of Program $ 410,425 $ 457,200 $ 564,500 <br /> Total # of Units 5195 5315 6500 <br /> Cost Per Unit $ 79 $ 86 $ 86 <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 11:54:37 AM Page 19 of 21 <br />