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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/Prograrr Summer Enrichment Camp <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Chan•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 $ 10,000 43% <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 <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 34 000 15% <br /> AGENCY EXPENSES <br /> Compensation 0 <br /> Rent&Utilities <br /> Supplies&Equipment _-_ 0 <br /> Travel&Training __- 0 <br /> Other Expenses: --- 0 <br /> Please list 3 largest"Other Expenses": <br /> $ - <br /> $ - <br /> $ - <br /> Total Agency Expenses 0 <br /> SURPLUS/(DEFICIT)FOR PERIOD: I $ 5,000 I $ 29,500 I $ 34,000 I 15% <br /> Main Application1/25/2016P a g e 23 of 32 <br />