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DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> h) Agency Budget <br /> i. Is your agency currently receiving and/or requesting other(non-Human Services) <br /> local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? <br /> (Yes/No) Yes <br /> If yes, please list below: <br /> Program FY16-17 Award FY17-18 Source <br /> Request <br /> Boomerang $27,312 + $8,194 = 35 500 Juvenile Crime Prevention <br /> $35,506 Council + County Match <br /> ii. Submit your agency's budget. ATTACHED <br /> iii. Does your agency budget show a Surplus or Deficit? Deficit <br /> Is there a significant change? Yes/No No <br /> Please provide a brief explanation for Surplus or Deficit, and significant changes. <br /> A deficit of$6,037 is projected for FY 2017-18. This should be offset by the projected <br /> surplus shown for FY 2016-17. <br /> iv. What is your agency's fiscal year? July 1, 2017 — June 30, 2018 <br /> 6 of 15 <br />