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<br />Agency Information 1/18/2018 7:54:45 PM Page 15 of 29 <br /> <br />h) Agency Budget <br /> <br />i. Is your agency currently receiving and/or requesting other (non-Human <br />Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) <br />government funding? (Yes/No) NO <br /> <br />If yes, please list below: <br />Include all programs that have funding requests/awards/totals from Carrboro, Chapel <br />Hill, and Orange County governments (other than Human Services). DO NOT include <br />federal funding sources, such as CDBG and HOME. I deleted this table as it did not <br />pertain to our agency. <br /> <br /> <br />ii. Submit your agency’s budget. You may complete the provided template <br />(separate xls file) or you may submit your own budget file (as long as it <br />contains the same information, and in a similar format, as requested in the <br />provided template). THIS IS INCLUDED WITH OUR ATTACHMENTS. <br /> <br /> <br /> <br /> <br /> <br /> <br />Agency Budgets are required to define budget amounts for the previous <br />program year, current program year, and next program year for the <br />following categories: <br /> <br />• Revenues <br />o Private Donations <br />o Program Generated Revenue <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 />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 />Exhibit A: <br />Provider's Outside Agency Application <br />DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606