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DocuSign Envelope ID: E9DE81F9-0070-4074-8F70-93DABC24ACE1 A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> h.) 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/inth 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 $9,000 <br /> Complete the table below for the project/program for which you are requesting <br /> funds. Attach additional rows/pages, as needed. <br /> Program: Community Education and Civic Engagement (Projected '16- <br /> '17) <br /> Cost Elements , Cost($)* Quantity/Unit of measure Subtotal ($) <br /> Teens Climb High** $41.67 2400 (240 students x 10 $100,00 <br /> sessions) <br /> $13.35 <br /> Information and Referral 1500 (contacts per yr.) $20,025 <br /> 35 <br /> Adult Communit Education $13. 2433 people per r. $32,481 <br /> 35 <br /> Youth Community Education $13. 2740 (1370 people x 2 sessions $36,579 <br /> per yr.) <br /> Total $189,063 <br /> *denotes a rounded average amount <br /> **This program has been and will continue to be fully funded by the state's Dept. of Public Health <br /> Define one unit of service: Each Information and Referral Service contact, one attendee at an adult <br /> community education presentation (professional or community interpersonal violence education/prevention, <br /> agency services, DVAM, WHM),one session of participation in youth interpersonal violence education (Start <br /> Strong), each session of participation in adolescent evidence-based sexual health curricula (Teens Climb <br /> High). <br /> Note:we are no longer counting e-newsletter opens as part of these units of service because we don't <br /> believe there is enough educational content to justify this as a service. We are adding Teens Climb High in <br /> Main Application 1/24/2016 2:59:42 PM Page 55 of 58 <br />