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DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <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?Yes <br /> Is there a significant change? Yes/No No <br /> Please provide a brief explanation for Surplus or Deficit, and significant changes. <br /> iv. What is your agency's fiscal year? July 1, 2016-June 30, 2017 <br /> (Example: July 1, 2016 through June 30, 2017) <br /> Agency Information 1/27/2017 3:10:56 PM <br />