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DocuSign Envelope ID: EB541A3B-1E01-49AB-9E09-7987ECAEC1C4 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Program Budget <br /> Agency/Program: Summer Enrichment Camp <br /> ,4 $,Alitua! Fstlmate Projected,> 5#,P, tt <br /> AGENCY REVENUE 0144-5. y'' .,'2i115`i6,;'; ,2Q16 4T K C,h�itt e <br /> Private Donations $ 1,000 $ 3,000 $ 5 000 67% <br /> Agency Generated Revenue(fees) 0 <br /> Local Government Grants: <br /> Orange County $ 1,500 $ 7,000 $ 10,900 56% <br /> Town of Chapel Hill $ 1 500 $ 2,000 $ 1,000 -50% <br /> Town of Carrboro $ 1,000 $ 2,500 $ 3 000 20% <br /> Other Local: --- 0 <br /> Other Local: 0 <br /> Other Local: --- 0 <br /> If more than 3 sources,please <br /> provide a separate list. <br /> Non-Local Government Grants <br /> Triangle United Way --- 0 <br /> State Government 0 <br /> Federal Government 0 <br /> Other Grants:Z Smith Reynolds $ - $ 10 000 $ 10 000 0% <br /> Other Grants:Strowd Rose $ 5,000 $ 5,000 0% <br /> Miscellaneous/Other Revenue 0 <br /> Please list 3 largest Miscellanous sources: <br /> BNY Mellon $ 5,000.00 <br /> $ <br /> $ - <br /> Total Agency Revenue 5 000 29 500 34 900 '11 <br /> AGENCY EXPENSES <br /> Compensation 0 <br /> Rent&Utilities -__ 0 <br /> Supplies&Equipment --_ 0 <br /> Travel&Training 01111 0 <br /> Other Expenses: --_ 0 <br /> Please list 3 largest"Other Expenses": <br /> $ - <br /> $ <br /> Total Agency Expenses 0 <br /> SURPLUS/(DEFICIT)FOR PERIOD: '$ 5,000 I$ 29,500 I$ 34,900 I 18%l <br /> Main Application 2/2/2016 5:08:53 PM Page 24 of 32 <br />