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DocuSign Envelope ID: 557EOBA8 -OFDF- 4943- B10E- 6AB96D651F4B <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <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 (CDBGIHOMEfetc.) <br />• Private Foundation Grants <br />• 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? Surplus <br />Is there a significant change? Yes /No No <br />Please provide a brief explanation for Surplus or Deficit, and significant changes. <br />The increase of the Family Success Alliance Staff caused an increase in income <br />and compensation which manifested in a surplus. <br />iv. What is your agency's fiscal year? January 1 through December 31 <br />(Example: July 1, 2016 through June 30, 2017) <br />For the purposes of this report we have calculated the Agency and Program <br />Budget on a July to June fiscal year. <br />Agency Information 1/22/2018 3:21:37 PM P a g e 12 of 2 2 <br />