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DocuSign Envelope ID: 8E8982E7 -EFF8- 4214- 979D- 9D572ED220CC <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />p) Program Budget <br />1. Submit your program budget. You may complete the provided template (separate As <br />file) or you may submit your own budget file (as long as it contains the same information, <br />in the same format, as requested in the provided template). <br />Program Budget <br />Operating Budget for Entire Program <br />AGENCY NAME: <br />PROGRAM REVENUE <br />Private Donations & Sponsorships <br />Agency Generated Revenue (fees) <br />Local Government Grants: <br />Human Services - Carrboro <br />Other - Town of Carrboro <br />Human Services - Chapel Hill <br />Other - Town of Chapel Hill <br />Human Services - Orange County <br />Other - Orange County <br />Other - Town of Hillsborough <br />Other Government Grants <br />Triangle United Way <br />State Government <br />Federal Government <br />Private Foundation Grants <br />Other Revenue <br />Total Program Revenue <br />PROGRAM EXPENSES <br />Compensation, taxes & insurance <br />Supplies & Equipment <br />Travel & Training <br />Other Expenses: <br />Total Program Expenses <br />SURPLUS /(DEFICIT) FOR PERIOD: <br />Hillsborough Arts Council <br />Actual <br />2016 -17 <br />Estimated <br />2017 -18 <br />Projected <br />2018 -19 <br />Percent <br />Change <br />$4,000 <br />$3,000 <br />$12,000 <br />300% <br />$2,300 <br />$1,050 <br />$5,000 <br />376% <br />0 <br />0 <br />0 <br />0 <br />$7,500 <br />$9,750 <br />$16,500 <br />69% <br />0 <br />$10,000 <br />1 $10,000 <br />1 $16,500 <br />1 65% <br />0 <br />0 <br />0 <br />0 <br />0 <br />$23,800 <br />$23,800 <br />$23,800 <br />$23,800 <br />$50,000 <br />$50,000 <br />110% <br />110% <br />0 <br />0 <br />0 <br />$23,800 <br />$23,800 <br />$50,000 <br />110% <br />$0 I $0 I $0 <br />PROGRAM INFORMATION 2/11/2018 4:28:29 PM Page 23 of 26 <br />