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DocuSign Envelope ID: D9639255-8147-4A2F-A760-941BDE078E48 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 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 $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: S•oke'n Revolutions' Trail of Tears Tour 2017 <br /> Cost Elements Cost( ) Quantity/Unit of measure Subtotal( ) <br /> Program Participants and Chaperones 222.75 13 2895.75 <br /> Camping Accommodations 86.85 15 1302.75 <br /> Food 166.04 15 2490.71 <br /> Support Vehicle Fuel 1990.19 1 1990.19 <br /> Contract Services 1875.00 1 1875.00 <br /> Tour Jerseys 76 15 1140.00 <br /> Insurance 1688.00 1 1688.00 <br /> Total 13,382.40 <br /> C.) Cost per Unit <br /> Actual 2014-15 Estimated 2015-16 Projected 2016-17 <br /> Total Cost of Program 13,828.00 13,382.40 15,000.00 <br /> Total # of Units 15 15 15 <br /> Cost Per Unit 921.86 892.16 1000.00 <br /> This Cost Per Unit must reflect the total program budget and the total number of <br /> program beneficiaries (households or persons) in this application and must be <br /> consistent with report submittals from previous years (if applicable). <br /> Main Application 5/25/2016 10:17:47 AM P 15 of 20 <br />