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DocuSign Envelope ID: CC5DDEFF- F35B- 45F1- AD01- 4586504D8AF6 <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 Budgets are required to define budget amounts for the previous program <br />year, current program year, and next program year for the following categories: <br />• Revenues <br />• Private Donations <br />• Program Generated Revenue <br />• Local Government Grants <br />• Carrboro Human Services <br />• Carrboro Other <br />• Chapel Hill Human Services <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 (CDBG /HOME /etc.) <br />• Private Foundation Grants <br />• Other Revenue <br />• Expenditures <br />o Compensation <br />o Rent & Utilities <br />• Supplies & Equipment <br />• Travel & Training <br />• Other Expenses <br />2. Program Budget Detail — Provide description of "other" budget items, not defined. <br />Other items in the CEF Advocate Program budget include: <br />• Direct Member Support <br />• Insurance <br />• Online Services <br />• Conferences & Memberships <br />3. This program budget represents what percent of the agency budget? 40% <br />4. COST PER INDIVIDUAL <br />This Cost per Individual must reflect the total program budget divided by the total number of <br />program individuals in this application. <br />PROGRAM INFORMATION 1/22/2018 6:35:06 PM Page 22 of 25 <br />Actual 2016- <br />2017 <br />Estimated 2017- <br />2018 <br />Projected 2018- <br />2019 <br />Total Cost of Program <br />$176,551 <br />$195,868 <br />$202,559 <br />Total # of Individuals <br />590 <br />620 <br />675 <br />Cost Per Individual <br />$299.23 <br />$315.90 <br />$300.08 <br />PROGRAM INFORMATION 1/22/2018 6:35:06 PM Page 22 of 25 <br />