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Fn - r1 fnr the Cumma r Program IFC <br /> DocuSign Envelope ID:64D61581-25C0-4408-84C2-991109E2DF4C <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Actual Estimate Projected Percent <br /> PROGRAM REVENUE 2015-16 d 2016-17 2017-18 Change <br /> Private Donations $ - $ 3,200 $ 4,000 25% <br /> Program Generated Revenue(fees) $ - $ 468 $ 6,000 1182% <br /> Local Government Grants: <br /> Orange County $ - $ 1,500 0 <br /> Town of Chapel Hill $ - $ 1,500 0 <br /> Town of Carrboro $ - $ 1,500 0 <br /> Other Local: --- 0 <br /> Other Local: --- 0 <br /> Other Local: --- 0 <br /> a separate list. <br /> Non-Local Government Grants <br /> Triangle United Way ---- <br /> State Government $ - $ 5,000 $ - -100% <br /> Federal Government $ - $ - $ - 0 <br /> Other Grants: Foundations $ 8,300 $ 6,000 -28% <br /> Other Grants: Access To Recovery $ - $ - $ - 0 <br /> Miscellaneous/Other Revenue $ - $ - 0 <br /> Please list 3 largest Miscellanous sources: <br /> Endowment Inc <br /> Events <br /> CDBG <br /> Total Program Revenue $ - $16 968 $20 500 21% <br /> PROGRAM EXPENSES <br /> Compensation $ 16,000 $ 19,000 19% <br /> Rent&Utilities $ - 0 <br /> Supplies&Equipment $ 2,000 $ 3,000 50% <br /> Travel&Training $ - 0 <br /> Other Expenses: $ - 0 <br /> Please list 3 largest"Other Expenses": <br /> Crisis Intervention Program <br /> Professional Fees <br /> Food <br /> Total Program Expenses $ - $18 000 $22 000 22% <br /> SURPLUS/(DEFICIT)FOR PERIOD: $ - $ (1,032)1 $ (1,500)1 -45% <br />