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DocuSign Envelope ID: 1640431D- 872F- 4BC9- ACA1- 2226D9788920 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <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? Deficit <br />Is there a significant change? Yes /No Yes <br />The deficit estimate and significant change is based on added staffing beginning in 2018. <br />iv. What is your agency's fiscal year? July 1 2018 through June 30 2019 <br />(Example: July 9, 2096 through June 30, 2017) <br />Agency Information 1/22/2018 6:18:22 PM Page 10 of 22 <br />