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DocuSign Envelope ID:88377437-EE99-4E08-B6B1-CD4F113C0672 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> c) 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 /> Please refer to the attachment titled "BITS Agency and Program Budgets" to view the <br /> wheelchair basketball program budget. <br /> 6. Program Budget Detail — Provide description of "other" budget items, not defined. <br /> We do not have "other" budget items provided in our boccia program budget. <br /> 7. This program budget represents what percent of the agency budget? 2.1% <br /> 8. 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 /> Actual 2015-16 Estimated 2016-17 Projected 2017-18 <br /> Total Cost of Program $21,006 $22,056 $23,159 <br /> Total # of Individuals 373 392 412 <br /> Cost Per Individual $56 $56 $56 <br /> PROGRAM INFORMATION 1/27/2017 3:48:29 PM P g c 21 of 2G <br />