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DocuSign Envelope ID: E9DE81F9-0070-4074-8F70-93DABC24ACE1 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 <br /> below, including the cost of each element, the quantity and unit of measure, and the subtotal for <br /> each element. 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 $9,000 <br /> Complete the table below for the project/program for which you are requesting <br /> funds. Attach additional rows/pages, as needed. <br /> Program: Domestic Violence Crisis Services (Projected '16-17) <br /> Cost Elements Cost($)* Quantity/Unit of measure Subtotal ($) <br /> Crisis Counseling $15.29 7600 (#clients yr. X 15 min. of $116,204 <br /> service) <br /> $15.29 Information (education, all non-crisis $15. 7100 (#clients yr. X 15 min. of $108,559 <br /> informational contacts, and follow ups) service) <br /> 29 <br /> Referral $15. 677 (#clients yr. X 15 min. of $10,351 <br /> service) <br /> Shelter referral &assistance/hotel $15.29 270 (#clients yr. X 15 min. of $4,128 <br /> placement service) <br /> $15.29 Legal information $15. 1270 (#clients yr. X 15 min. of $19,418 <br /> service) <br /> $15.29 <br /> DV Protective Order paperwork assistance 330 (#clients yr. X 15 min. of $5,046 <br /> service) <br /> 29 <br /> Advocacy(general & court) $15. 22000 (#clients yr. X 15 min. of $33,638 <br /> service) <br /> $15.29 Interpretation $15. 155 (#clients yr. X 15 min. of $2,370 <br /> service) <br /> Financial assistance (transportation, $15.29 142 (#clients yr. X 15 min. of $2,171 <br /> grocery cards, gas cards, food/toiletries) service) <br /> Main Application 1/24/2016 2:59:42 PM Page 49 of 58 <br />