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DocuSign Envelope ID:ODO4B5DD-363F-41 FF-BD24-FAD291133B51 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <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 /> iii. Does your agency budget show a Surplus or Deficit? A small surplus for FY 2016 <br /> and a balanced budget for FY 2017 and FY2018. <br /> Is there a significant change? No <br /> Provide a brief explanation for Surplus or Deficit, and significant changes. N/A <br /> iv. What is your agency's fiscal year? OCLW adopted the calendar year (January 1 — <br /> December 31) for its fiscal year. However, all of the numbers reported in budgets <br /> for the purposes of this grant application have been converted to the county's fiscal <br /> year (July 1 — June 30). <br /> DO NOT SUBMIT THIS PAGE 12/15/2016 9:57:17 AMII'age 17 •f 32 <br />