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DocuSign Envelope ID:0E0892A5-AB8C-4E61-8B53-2125B8922B1C XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> f) Agency Budget <br /> i. Is your agency currently receiving and/or requesting other(non-Human Services) <br /> local (Town of Carrboro, Town of Chapel Hill, Orange County) government <br /> funding? (Yes/No) Yes. <br /> If yes, please list below: <br /> Include all programs that have funding requests/awards/totals from Carrboro, Chapel Hill, <br /> and Orange County governments (other than Human Services). DO NOT include federal <br /> funding sources, such as CDBG and HOME. <br /> Program FY16-17 FY17-18 Source <br /> Award Request <br /> Ex: Affordable Rental 0 $20,000 Carrboro -Affordable Housing <br /> Rehabilitation <br /> Ex: Agency Administration $15,000 $15,000 Carrboro—Other <br /> Ex. Total $15,000 $35,000 Carrboro Total Funding <br /> Kidzu Enrichment Activities $10,000 - Chapel Hill/ Parks and Recreation <br /> performance agreement (after <br /> school programming, visitor <br /> passes and family <br /> memberships) <br /> Agency Information 2/9/2017 1:27:17 PM 0:' g 11 of i <br />