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DocuSign Envelope ID: FOFFD659- 4159- 4D4C- 82FD- FF8E51A5A7E4 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <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 />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 />• Compensation <br />• Rent & Utilities <br />• Supplies & Equipment <br />• Travel & Training <br />• Other Expenses <br />iii. Does your agency budget show a Surplus or Deficit? Balanced Budget <br />Is there a significant change? Yes /No Yes <br />This current fiscal year we were able to pass a balanced budget after a deficit budget last <br />fiscal year. Additional dollars from the Governors Crime Commission helped fill some previous <br />gaps in funding for Domestic Violence and Administrative positions, and enabled us to add a <br />part -time Latinx Support Group Coordinator. For next fiscal year, we are requesting additional <br />support from the Town of Carrboro, Town of Chapel Hill and Orange County to increase our <br />Self - Sufficiency staffing capacity. <br />iv. What is your agency's fiscal year? July 1, 2018 through June 30, 2019 <br />(Example: July 9, 2016 through June 30, 2097) <br />Agency Information 1/22/2018 5:50:18 PM Page 13 of 47 <br />