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DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> • Program Budget <br /> 1. 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 /> 2. Program Budget Detail — Provide description of"other" budget items, not defined. <br /> • Admit.Me. Online support system where students get expert support on how to <br /> represent their academic background, activities, goals, and interests for schools. <br /> • Institute for Civic Engagement for Emerging Leaders. Cost for food, <br /> presenters, and instruction during two-week intensive summer enrichment <br /> academy for 50 students from MBK-related agencies. <br /> • MBK Opportunity Summits. Cost for food and presenters for two (2) MBK <br /> Opportunity Summits for high school students, college students, K-12 educators, <br /> and community and business leaders. Summits will focus on student <br /> achievement, career/personal/professional development, social justice and <br /> engagement, and mentorship. <br /> • Marketing. Costs associated with web design, photography, videography, and <br /> general promotion of MBK Orange County. <br /> 3. This program budget represents what percent of the agency budget? 12% <br /> °„ wpMl <br /> PROGRAM INFORMATION 1/31/2017 3:24:15 M IC: �� � o f 2 9 <br />