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DocuSign Envelope ID:AB039DC1-8309-4D41-B525-6E84F973FAA6 <br /> EXHIBIT A - PROVIDER'S OUTSIDE AGENCY APPLICATION CONTINUED <br /> MAIN APPLICATION <br /> Program Budget <br /> Agency/Program The Exchange Club's Family Center in Alameneei Parent Alde Services <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change <br /> Private Donations $ 1,500 $ 1,500 $ 2,500 67% <br /> Agency Generated Revenue(fees) 0 <br /> Local Government Grants: <br /> Orange County $ 2,000 $ 2,000 $ 10,350 418% <br /> Town of Chapel Hill $ 3,427 $ 6,000 $ 10,350 73%l <br /> Town of Canton) $ 1,000 $ 3,000 200%1 <br /> Other Local: 0 <br /> Other Local: 0 <br /> Other Local: 0 <br /> If more than 3 seurcos,please <br /> provide a separate list. <br /> Non-Local Government Grants <br /> Triangle United Way Ii <br /> Slate Government <br /> Federal Government <br /> Other Grants:Duke Endowment .1111 $ 23,700 0 <br /> Other Grants 0 <br /> Miscellaneous/Other Revenue 1.1.11.1111.1111 0 <br /> Reese list 3Iargest Miscellanous sources: <br /> Total Agency Revenue $ 10 500 49 900 <br /> AGENCY EXPENSES <br /> Compensation $ 3,178 MI $ 42,000 667% <br /> Rent&Utilities $ 1,552 $ 900 $ 3,000 233% <br /> Supplies&Equipment 31 $ 450 $ 900 100% <br /> Travel&Training $ 1,566 $ 3,675 $ 4,000 9% <br /> Other Expenses: 0 <br /> Pease list 3 largest"Other Expenses": <br /> $ <br /> - <br /> Total Agency Expenses IM 10,500 49 900 MI <br /> SURPLUS/(DEFICIT)FOR PERIOD: $ 600 ri 0 $ 100% <br /> Main Application 1/24/2016 4:55:46 PM Page 18 of 2 1 <br />