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DocuSign Envelope ID:FO3CBAC2-B7E2-4CDB-AFA6-CB52A071BA00 t A- continued <br /> Provider's Outside Agency Application <br /> MAIN APPLOCAT1ON <br /> 4. FINANCIAL INFORMATION FOR SERVICE PROGRAMS <br /> a.) Program Budget <br /> Please complete a Program Budget Excel Form f-r each requested program. The <br /> Program Budget should reflect only figures and amounts associated with the Program(s) for <br /> which you are seeking funding and not the total agency budget. <br /> If the program's finances experienced significant changes that you would like to explain, <br /> please use the space below. <br /> It is required that your Excel budget worksheet be embedded on the next page. You must <br /> also submit an electronic copy of the MS Excel file with your application, as a separate file, <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, aflocate costs to the use of shared space vehicles or equipment. <br /> Exam le 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 Counsel* reacher (-.;lass prep $25 48 hours (4hrs/mth A"1.2 roUis) $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 /> Main Application 1/25/2016 1:26:31 PM p ,; 1 5 5 1 1 5 <br />