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DocuSign Envelope ID: COBB49A6 -D1 E9- 42DE- 8E8D- 7583E683E1E2 <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 />• Other Government Grants <br />• Triangle United Way <br />• State Government <br />• Federal Government (CDBGfHOMEletc.) <br />• Private Foundation Grants <br />• Other Revenue <br />• Expenditures <br />• Compensation <br />• Rent & Utilities <br />• Supplies & Equipment <br />• Travel & Training <br />• Other Expenses <br />A 8 C D <br />AGENCY NAME: <br />E I G I I } J <br />,Agency Budget <br />_0Pemgn9_Budgst for_-Erore Agency <br />AGENCY REVENUE <br />;Private [zonations <br />9 _JAeency Generated Revenue (fees) <br />10 ;Local Government Grants: <br />11 _ Human Services - Town of Carrbory <br />12 Other - Town o; Carrboro <br />13 € .a Human Services - Town of Chapel HIP <br />4 Other - Town of Chapel Hill <br />15� Human Services - Orange County <br />16 _ tither - orange County <br />17 _ "r- TownofHillsborough <br />1$ Other Government Grant_s___ <br />19 Triangle United Way <br />20 State Govemment <br />21 Federal Government (C7BG?HOME/etc.) <br />22 Private Foundation Grants <br />24 <br />r - Other Revenue P <br />-- . _ ..... <br />25 .. <br />26 'Total Agency Revenue <br />27 <br />28 AGENCY EXPENSES <br />29 Compensation <br />Rent & Utilities <br />3' Supplies & Equipment <br />32 Travel & Training <br />33 Other Expenses: <br />34 <br />35 Total Agency Expenses <br />36 <br />37 <br />38 'SURPLUS/(DEFICIT) FOR PERIOD: <br />39 <br />40 <br />ws.,b <br />L <br />2. Program Budget Detail — Provide description of "other" budget items, not defined. <br />PROGRAM INFORMATION 1/2112018 12:07:58 PM cii :_€ x i <br />Actual <br />2016.17 <br />Estimated <br />2017 -18 <br />Projected <br />2018 -19 <br />Percent <br />Change <br />$ <br />2,023 <br />$ <br />2,461 <br />$ <br />3,300 <br />22% <br />$ <br />$ <br />0 <br />$ <br />$ <br />$ <br />8,000 <br />0 <br />S <br />$ <br />S <br />0 <br />$ <br />S <br />91000 <br />0 <br />$ <br />$ <br />$ <br />- <br />0 <br />$ <br />16,750 <br />$ <br />17,725 <br />$ <br />20,000 <br />13% <br />$ <br />- <br />$ <br />$ <br />_ _ _ 0 <br />5 <br />S <br />S <br />0 <br />5 <br />$ <br />S <br />0 <br />$ <br />S <br />0 <br />5 <br />1,000 00 <br />S <br />5,000 00 <br />$ 4.00 <br />3,873 <br />S <br />0 <br />$ <br />$ <br />22,446 <br />8.059 <br />$ <br />$ <br />21,188 <br />12.000 <br />$ <br />S <br />43,000 <br />24,750 <br />103°% <br />10B% <br />$ <br />S <br />$ <br />0 <br />$ <br />2,853 <br />S <br />6,030 <br />$ <br />7;500 <br />24% <br />$ <br />1,500 <br />5 <br />- <br />$ <br />0 <br />4 082 <br />2 894 <br />$ <br />10 500 <br />283% <br />$ <br />17,394 <br />$ <br />20,924 <br />$ <br />42,750 <br />1 104% <br />2. Program Budget Detail — Provide description of "other" budget items, not defined. <br />PROGRAM INFORMATION 1/2112018 12:07:58 PM cii :_€ x i <br />