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DocuSign Envelope ID: 07FEE1A8- E83F- 44CF- 99C4- 6lA6E4C39BD2 <br />EXHIBIT A - PROVIDER'S OUTSIDE AGENCY APPLICATION <br />• 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 />• 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 />iii. Does your agency budget show a Surplus or Deficit? Yes <br />Is there a significant change? Yes /No No, unchanging surplus of $2,000 <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 through June 30, 2017 <br />(Example: July 1, 2016 through June 30, 2017) <br />Agency Information 2/9/2017 4:31:06 PM Page 10 of 22 <br />