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DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <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? Surplus <br /> Is there a significant change? Yes/No Yes <br /> Please provide a brief explanation for Surplus or Deficit, and significant changes,. <br /> There is a small surplus due to revenue slightly exceeded expenses. <br /> The William R. Kenan, Jr. Charitable Trust challenge grant and AmeriCorps State <br /> Funding will mark a significant increase in funding from previous years, increasing our <br /> staff and internal capacity. <br /> iv. What is your agency's fiscal year? Janua 1 through December 31 <br /> (Example: July 1, 2016 through June 30, 2017) <br /> Agency Information 1/31/2017 3:24:15 PM P a g pH 29 <br />