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DocuSign Envelope ID:6D821DA0-CO6F-4D38-BB4F-DB28CB54AD8E XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 2. Program Budget Detail — Provide description of "other" budget items, not <br /> defined. <br /> No "other" budget items noted. <br /> 3. This program budget represents what percent of the agency budget? <br /> 19% <br /> 4. COST PER INDIVIDUAL <br /> This Cost per Individual must reflect the total program budget divided by the total number of <br /> program individuals in this application. <br /> Actual 2015-16 Estimated 2016-17 Projected 2017-18 <br /> Total Cost of Program $ 1,280,535 $ 1,291,704 $ 1,306,265 <br /> Total # of Individuals 210 210 210 <br /> Cost Per Individual $6,098 $6,151 $6,221 <br /> PROGRAM INFORMATION 1/31/2017 8.24.51 AM Pago 20 of 20 <br />