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DocuSign Envelope ID: 6818677A -D518- 4750- B391- F6169FB2A4C4 <br />Exhibit A: Provider's Outside Agency Application <br />h) Agency Budget <br />L 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) No <br />if yes, please list below: <br />include all programs that have funding requestslawardsltotals from Garrboro, Chapel <br />and Oran a Count governments (other than Human Services). DO NOT include federal <br />funding sources, such as CDBG and HOME. <br />*Add rows or attacn acionionai pays, ii i iv--- <br />ii. Submit your agency's budget. You may complete the provided template (separate <br />As file) or you may submit your own budget file (as long as it contains the same <br />information, and in a similar format, as requested in the provided template). <br />iii. Does your agency budget show a Surplus or Deficit? Neither <br />Is there a significant change? Yes/No No <br />iv. What is your agency's fiscal year? July 1 through June 30 <br />Agency Information 1/2312018 11:40:33 AM P 3 cj , 1 <br />