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DocuSign Envelope ID: E7784BE7- 82AF- 4AF1- AA11- 944D2300E76D <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Program Budget <br />Operating Budget for Program <br />AGENCY NAME: Chapel Hill Training- Outreach Project, Inc. (KidSCope) <br />PROGRAM REVENUE <br />Private Donations <br />Program Generated Revenue (fees) <br />Local Government Grants: <br />Orange County <br />Town of Chapel Hill <br />Town of Carrboro <br />Chatham County <br />Other Local: Strowd Roses <br />Other Local: Misc <br />provide a separate list. <br />Other Government Grants <br />Triangle United Way <br />State Government <br />Federal Government <br />Other Grants: <br />Other Grants: <br />Miscellaneous/Other Revenue <br />Please list 3 largest Miscellaneous sources: <br />Total Program Revenue <br />PROGRAM EXPENSES <br />Compensation <br />Rent & Utilities <br />Supplies & Equipment <br />Travel & Training <br />Other Expenses: <br />Please list 3 largest "Other Expenses ": <br />Indirect cost to CHTOP, Inc. $ 7,957.00 <br />Occupancy costs $ 800.00 <br />Computer Maintenance $ 5,000.00 <br />Total Program Expenses <br />SURPLUS /(DEFICIT) FOR PERIOD: 1 ($59,905) ($26,878) ($26,878) 0% <br />p) Program Budget <br />PROGRAM INFORMATION 1/22/2018 3:23:54 PM P a g e 23 of 27 <br />Actual <br />2016 -17 <br />Estimated <br />2017 -18 <br />Projected <br />2018 -19 <br />Percent <br />Change <br />$ <br />8,557 <br />$ <br />11,000 <br />$ <br />11,000 <br />0% <br />$ <br />21,024 <br />$ <br />21,000 <br />$ <br />21,000 <br />0% <br />$ <br />75,000 <br />$ <br />75,000 <br />$ <br />75,000 <br />0% <br />$ <br />4,500 <br />$ <br />4,500 <br />$ <br />4,500 <br />0% <br />$ <br />2,200 <br />$ <br />2,200 <br />$ <br />2,200 <br />0% <br />0 <br />$ <br />5,000 <br />$ <br />5,000 <br />0% <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />$ <br />$ <br />111 281 <br />110,129 <br />$ <br />$ <br />118 700 <br />88,407 <br />$ <br />$ <br />118 700 <br />88,407 <br />0% <br />0% <br />$ <br />17,936 <br />$ <br />24,834 <br />$ <br />24,834 <br />0% <br />$ <br />2,202 <br />$ <br />2,600 <br />$ <br />2,600 <br />0% <br />$ <br />6,224 <br />$ <br />9,000 <br />$ <br />9,000 <br />0% <br />$ <br />34,695 <br />$ <br />20,737 <br />$ <br />20,737 <br />0% <br />$ 171,186 <br />$ 145,578 <br />$145,578 <br />V0 <br />SURPLUS /(DEFICIT) FOR PERIOD: 1 ($59,905) ($26,878) ($26,878) 0% <br />p) Program Budget <br />PROGRAM INFORMATION 1/22/2018 3:23:54 PM P a g e 23 of 27 <br />