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DocuSign Envelope ID: DDOCFB62- 8EDD- 4B57- ACF6- 9C98BO78AA95 XHIBIT A <br />iv. <br />PROVIDER'S OUTSIDE AGENCY APPLICATION <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 <br />here) <br />• Other Government Grants <br />• Triangle United Way <br />• State Government <br />• Federal Government (CDBG /HOME /etc.) <br />• Private Foundation Grants <br />• Other Revenue <br />Expenditures <br />• Compensation <br />• Rent & Utilities <br />• Supplies & Equipment <br />• Travel & Training <br />• Other Expenses <br />Does your agency budget show a Surplus or Deficit? Yes — in FY2016 only <br />Is there a significant change? Yes /No Yes <br />Please provide a brief explanation for Surplus or Deficit, and significant changes. <br />FY2016 Surplus — was due to better than expected contracts, along with slower <br />than expected spending with our citizenship grant ( USCIS). <br />Significant changes — The grant period for our citizenship grant is October 1, <br />2015 - September 30, 2017. We are told that the Federal register notice for a <br />second round of funding will be coming out in May /June. However, since it is not <br />already out, and there is no assurance of a second round, we have chosen to <br />budget for FY2018, showing only one quarter (July -Sept) of USCIS funding. <br />What is your agency's fiscal year? <br />(Example: July 1, 2016 through June 30, 2017) <br />July 1, 2016 -June 30, 2017 <br />Agency Information 1/31/2017 10:54:56 AM Page 7 of 26 <br />