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DocuSign Envelope ID: 1A43D806-0D44-4AC1-898C-3042FDBCA241 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 2. Program Budget Detail — Provide description of "other" budget items, not defined. <br /> "Other Expenses" included on the budget worksheet include: 1) reimbursement/ payments to <br /> child care providers for children on scholarships; and 2) administrative overhead. <br /> 3. This program budget represents what percent of the agency budget? 2.3% <br /> 4. COST PER INDIVIDUAL <br /> This Cost per Individual must reflect the total program budget divided by the total number of program <br /> individuals in this application. <br /> Actual 2015-16 Estimated 2016-17 Projected 2017-18 <br /> Total Cost of Program $558,370 $544,564 $581,248 <br /> Total # of Individuals 113 110 120 <br /> — <br /> Cost Per Individual $4,941 $4,950 $4,844 <br /> PROGRAM INFORMATION 1/27/2017 8:51:47 AM H t <br />