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DocuSign Envelope ID:B32F3E9F-996A-4000-8CAF-83514F2E5759 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 I 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 1 $20 120 hours (10 hrs/mth x12 mths $2,400 <br /> Materials $25 120 course packets/credit reports $3,000 <br /> Total $9,000 <br /> Complete the table below for the project/program for which you are requesting funds. <br /> Attach additional rows/pages, as needed. <br /> Program: 2015-2016 Weekend Meal Backpack Program <br /> Cost Elements Cost($) Quantity/Unit of measure Subtotal_($) <br /> Food $1.69/1b 500 kids x 33 weeks x1.69/1b x 8 223,080 <br /> lbs food <br /> Supplies (paper, sharpies, laundry bins, $230 $230 in various supplies x 12 2770 <br /> shelves, scales, etc.)– used for dating, I months <br /> distribution, and tracking of food, <br /> Vehicle Maintenance (fuel, taxes, title, $577 $577/month for 12 months for 2 6,924 <br /> insurance, etc) vehicles <br /> I Program Director $2,622 $2,622/month for 12 months $31,465 <br /> Space Various I ($2,400 rent x 8 months for $41,235 <br /> 1,106sgft) = 19,200 + <br /> ($3,500 rent x 4 months for <br /> 3,000sgft) = 14,000 + <br /> Utilities at an average of <br /> 670/month for 12 months) <br /> =$8,035 <br /> $19,200 + $14,000 + $8,035 <br /> 50% Executive Director(grants, $1,899 $1,899/month for 12 months $22,787 <br /> consultation, program planning, etc) <br /> IT Services for Program Record Keeping $105 $105/month for 12 months $1 260 <br /> I Other Staff $508 $508/month for 12 months for 2 $6,090 <br /> part-time staff members <br /> Main Application 1/25/2016 11 :34:49 AM a 1 1B n <br />