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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/Progran Back to School Bash <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Chan•e <br /> Private Donations $ 3,000 $ 5,000 $ 7,000 40% <br /> Agency Generated Revenue (fees) 0 <br /> Local Government Grants: <br /> Orange County $ 10,000 $ 15,000 $ 20,000 33% <br /> Town of Chapel Hill $ 2,000 $ 2,500 $ 3,000 20% <br /> Town of Carrboro $ 2,500 $ 3,000 $ 3,500 17% <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 Govemment 0 <br /> Federal Government --- 0 <br /> Other Grants:Z Smith Reynolds $ - $ 10,000 $ 10,000 0% <br /> Other Grants: --- 0 <br /> Miscellaneous/Other Revenue 0 <br /> Please list 3 largest Miscellanous sources: <br /> $ - <br /> $ - <br /> $ - <br /> Total Agency Revenue 17 500 35 500 43 500 23% <br /> AGENCY EXPENSES <br /> Compensation �-� 0 <br /> Rent&Utilities 0 <br /> Supplies&Equipment 0 <br /> Travel &Training 0 <br /> Other Expenses: <br /> 0 <br /> Please list 3 largest"Other Expenses": <br /> $ - <br /> $ - <br /> $ - <br /> Total Agency Expenses 11111.111111111.11111 0 <br /> SURPLUS/(DEFICIT)FOR PERIOD: L$ 17,500 I $ 35,500 I $ 43,500 I 23% <br /> Main Application1/25/20161 a g e 22 of 32 <br />