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DocuSign Envelope ID:8A1AB1 BF-ACDB-42A1-A3DE-9E9549E569B4 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Program Budgets are required to define budget amounts for the <br /> previous program year, current program year, and next program year for <br /> the following categories: <br /> 2. Program Budget Detail—Provide description of"other" budget items, not <br /> defined. <br /> Donation Station Program <br /> PROGRAM EXPENSES FY15-16 1 FY16-17 FY 17-18 <br /> Compensation $ 48,000 $ 55,959'$ 61,568 <br /> Rent & Utilities $ 5,000 $ 5,000 $ 5,960 <br /> Supplies & Equipment $ 7,500 $ 8,630 $ 10,285 <br /> Travel & Training $ 5,500 $ 6,310 $ 7,420 <br /> 3. This program budget represents what percent of the agency budget? <br /> 11.7 % for the Donation Station Program. <br /> 4. COST PER INDIVIDUAL <br /> This Cost per Individual must reflect the total program budget divided by the total <br /> number of program individuals in this application. <br /> n tioa Station Munn 2 r5- Estimated 2 1 ,,i Projected i 200( <br /> Total Cost of Program $66,000 $75,899 $85,233 <br /> Total # of Individuals 7,900 8,300 9,000 <br /> Cost Per Individual $8.30 $9.14 $9.40 <br /> Page 17 of 20 <br />