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DocuSign Envelope ID: 571863E8-F892-43F0-B73F-4AB062ACBOBF XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> n) Program Budget <br /> 1. Submit your program budget. You may complete the provided template <br /> (separate xls file) or you may submit your own budget file (as long as it contains <br /> the same information, in the same format, as requested in the provided template). <br /> Program Budgets are required to define budget amounts for the previous <br /> program year, current program year, and next program year for the <br /> 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 <br /> defined. Professional fees and business expenses (marketing, insurance, etc.). <br /> 3. This program budget represents what percent of the agency budget? <br /> 7.5% <br /> DO NOT SUBMIT THIS PAGE 1/26/2017 11:10:15 AMII'age 27 •r 31 <br />