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DocuSign Envelope ID: 8E8982E7 -EFF8- 4214- 979D- 9D572ED220CC <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />2. Program Budget Detail — Provide description of "other" budget items, not defined. <br />3. This program budget represents what percent of the agency budget? <br />50,000 = 140,000 = 0.357, or 36% <br />4. COST PER INDIVIDUAL <br />This Cost per Individual must reflect the total program budget divided by the total <br />number of program individuals in this application. <br />PROGRAM INFORMATION 2/11/2018 4:28:29 PM Page 24 of 26 <br />Actual 2016 -17 <br />Estimated 2017 -18 <br />Projected 2018 -19 <br />Total Cost of Program <br />$23,800 <br />$23,800 <br />$50,000 <br />Total # of Individuals <br />19,000 <br />21,000 <br />23,000 <br />Cost Per Individual <br />$1.25 <br />$1.13 <br />$2.17 <br />PROGRAM INFORMATION 2/11/2018 4:28:29 PM Page 24 of 26 <br />