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DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> re-enter the community and/or family. <br /> Next Year Projected Results Of the 77% of clients who graduate from the program, <br /> another 10% will successfully discharge to ADATC or <br /> other appropriate level of care. <br /> 6. Program Activity Name Staff develops a Person-Centered Plan for each <br /> individual, with a goal of self-sufficiency and sobriety <br /> upon graduation. <br /> Program Goal 65% of clients who graduate will secure housing upon <br /> discharge. <br /> Performance Measures Follow up surveys and a 3 month follow-up plan are <br /> used to gain this information regarding housing. <br /> Previous Year Program Results 64% of clients who graduate will secure housing upon <br /> discharge. <br /> Current Year Estimated Results 64% of clients who graduate will secure housing upon <br /> discharge. <br /> Next Year Projected Results 65% of clients who graduate will secure housing upon <br /> dischar e. <br /> z) Program Budget <br /> 5. Submit your program budget. You may complete the provided template (separate xls <br /> file) or you may submit your own budget file (as long as it contains the same information, <br /> in the same format, as requested in the provided template). <br /> Program Budgets are required to define budget amounts for the previous program <br /> year, current program year, and next program year for the following categories: <br /> • Revenues <br /> o Private Donations <br /> o Program Generated Revenue <br /> o Local Government Grants <br /> • Carrboro Human Services <br /> • Carrboro Other <br /> • Chapel Hill Human Services <br /> • Chapel Hill Other(DO NOT include CDBG funding here) <br /> • Orange County Human Services <br /> • Orange County Other(DO NOT Include HOME funding here) <br /> o Other Government Grants <br /> • Triangle United Way <br /> • State Government <br /> • Federal Government (CDBG/HOME/etc.) <br /> • Private Foundation Grants <br /> o Other Revenue <br /> • Expenditures <br /> o Compensation <br /> o Rent & Utilities <br /> o Supplies & Equipment <br /> o Travel & Training <br /> o Other Expenses <br /> DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 24 of <br />