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DocuSign Envelope ID:9B26E979-2C09-4BE7-801C-3DDB484D92EE XHIBIT A <br /> PROVIDER"S OUTSIDE AGENCY APPLICATION <br /> g) Living Wage <br /> Does this agency pay permanent employees a minimum living wage? (Yes/No) n/a <br /> If yes, is this agency an Orange County Living Wage Certified Employer? <br /> If no, please explain. <br /> There are no employees. This is an all- volunteer organization. <br /> h) Agency Budget <br /> i. Is your agency currently receiving and/or requesting other(non-Human Services) <br /> local (Town of Carrboro, Town of Chapel Hill, Orange County) government <br /> funding? (Yes/No) no <br /> If yes, please list below: <br /> Include all programs that have funding requests/awards/totals from Carrboro, Chapel Hill, <br /> and Orange County governments (other than Human Services). DO NOT include federal <br /> funding sources, such as CDBG and HOME. <br /> Program FY16-17 FY17-18 Source <br /> Award Request <br /> Ex: Affordable Rental 0 $20,000 Carrboro -Affordable Housing <br /> Rehabilitation <br /> Ex: Agency Administration $15,000 $15,000 Carrboro—Other <br /> Ex. Total $15,000 $35,000 Carrboro Total Funding <br /> *Add rows or attach additional page, if needed. <br /> ii. Submit your agency's budget. You may complete the provided template (separate <br /> xls file) or you may submit your own budget file <br /> Budget included in attachments <br /> Agency Information 2/8/2017 4:36:09 PM Page lr "' ' <br />