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DocuSign Envelope ID:8A1AB1 BF-ACDB-42A1-A3DE-9E9549E569B4 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> • Calculate a Full Time Equivalent for all recorded volunteer hours using the <br /> following: <br /> Total Volunteer Hours = Volunteer FTE <br /> 2,080 .� <br /> # of FTE - Full-Time Paid Positions: 5 <br /> # of FTE - Paid Part-Time Positions: 1.25 <br /> # of Volunteers: 230 # of FTE -Volunteers:10,000 <br /> g) Living Wage <br /> Does this agency pay permanent employees a minimum living wage? (Yes/No) <br /> YES <br /> If yes, is this agency an Oran se Count, Living We e Certified Em er? No <br /> If no, please explain. We hold a Living Wage Certification from Durham County <br /> because our office is physically located in Durham County. <br /> h) Agency Budget <br /> i. Is your agency currently receiving and/or requesting other (non-Human <br /> Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) <br /> government funding? (Yes/No) No <br /> If yes, please list below: <br /> Include all programs that have funding requests/awards/totals from Carrboro, <br /> Chapel Hill, and Orange County governments (other than Human Services). DO <br /> NOT include federal funding sources, such as CDBG and HOME. <br /> Program FY16- I FY17-18 Source <br /> 17 Request <br /> Award <br /> Donation Station Program 7 $2,500 $10,000 Orange County <br /> Donation Station Program $2,500 $5,000 Chapel Hill <br /> Donations Station Program $2,000 $5,000 Carrboro <br /> Total _.... ._ $7,000 I $20,000 Total Funding <br /> *Add rows or attach additional page, if needed. <br /> ii. Submit your agency's budget. You may complete the provided template <br /> (separate xls file) or you may submit your own budget file (as long as it <br /> Page 7 of 20 <br />