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DocuSign Envelope ID:E519448F-9F6D-4100-BF62-D7625621FFEB XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> ii. Submit your agency's budget. You may complete the provided template (separate <br /> xis file) or you may submit your own budget file (as long as it contains the same <br /> information, and in a similar format, as requested in the provided template). <br /> Agency 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 /> 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 /> Surplus of the agency budget represent funds that will be used to cover next fiscal year <br /> expenses since there is a $50,000 grant for Transplanting Tradition Community Farm that <br /> has ended and additional funding will be needed. <br /> iv. What is your agency's fiscal year? July 1, 2017 through June 30, 2018 <br /> (Example: July 1, 2016 through June 30, 2017) <br /> Agency Information 1/31/2017 3:59:06 PM Page 9 of 18 <br />