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DocuSign Envelope ID: 557EOBA8 -OFDF- 4943- B10E- 6AB96D651F4B <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />If no, please explain. <br />h) Agency Budget <br />i. Is your agency currently receiving and/or requesting other (non -Human Services) <br />local (Town of Carrboro, Town of Chapel Hill, Orange County) government <br />funding? (Yes/No) Yes <br />If yes, please list below: <br />Include all programs that have funding requests/awards/totals from Carrboro, Chapel Hill, <br />and Orange County governments (other than Human Services). DO NOT include federal <br />funding sources, such as CDBG and HOME. <br />Program <br />FY17 -18 <br />Award <br />FY18 -19 <br />Request <br />Source <br />Ex: Affordable Rental <br />Rehabilitation <br />0 <br />$20,000 <br />Carrboro - Affordable Housing <br />Ex: Agency Administration <br />$15,000 <br />$15,000 <br />Carrboro — Other <br />Ex. Total <br />$15,000 <br />$35,000 <br />Carrboro Total Funding <br />Affordable Housing Develop- <br />Mental Reserve, for property <br />acquisition <br />$54,128 <br />0 <br />Chapel Hill <br />Community Development <br />$11,000 <br />$27,000 <br />Town of Chapel Hill <br />Total <br />$65,128 <br />$27,000 <br />Total Funding <br />*Add rows or attach additional page, if needed. <br />Submit your agency's budget. You may complete the provided template (separate <br />xls file) or you may submit your own budget file (as long as it contains the same <br />information, and in a similar format, as requested in the provided template). <br />Agency 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 />o Private Donations <br />o Program Generated Revenue <br />o Local Government Grants <br />■ Carrboro Human Services <br />Agency Information 1/2212018 3 :21 :37 PM Pa g e 11 of 2 2 <br />