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DocuSign Envelope ID: E9DE81F9-0070-4074-8F70-93DABC24ACE1 A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> e.) 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(S) 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 $9,000 <br /> Complete the table below for the project/program for which you are requesting <br /> funds. Attach additional rows/pages, as needed. <br /> Program: Self-Sufficiency Programs (Projected 16-17) <br /> Cost Elements Cost Quantity/Unit of measure Subtotal <br /> f$'1 <br /> Legal Information Service $26.75 190 (190 sessions/yr. X 15 min. of $5,083 <br /> service) <br /> $26.75 <br /> Community Legal Project 104 (52 sessions x 2 units at 30min.) $2,782 <br /> $26.75 Legal Workshops $26. 480 (80 participants x 6 units at 1.5 $12,840 <br /> hr.) <br /> $26.75 Individual Career Counseling $26. 600 (150 sessions x 4 units at 1 hr.) $16,050 <br /> $26.75 Career Workshop $26. 180 (45 participants x 4 units at 1 hr.) $4,815 <br /> $26.75 Individual Financial Counseling $26. 660 (110 sessions x 6 units at 1.5 $17,655 <br /> hr. <br /> $26.75 Financial Workshops $26. 260 (65 participants x4 units at 1 hr.) $6,955 <br /> $26.75 <br /> VITA 1350 (225 clients x6 units at 1.5 hr.) $36,113 <br /> $26.75 <br /> Group 1410 (235 contacts x6 units at 1.5 $37,728 <br /> hr.) <br /> Total $140,020 <br /> *denotes a rounded average amount <br /> Main Application 1/24/2016 2:59:42 PM Page 5 2 o f 5 8 <br />