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DocuSign Envelope ID: A0992361- 7662- 4FD7- 9DB3- 9D760E06A5D2 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />3. This program budget represents what percent of the agency budget? 20% <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 1:53:42 PM Page 18 of 18 <br />Actual 2016 -17 <br />Estimated 2017 -18 <br />Projected 2018 -19 <br />Total Cost of Program <br />$1,257,220 <br />$1,329,889 <br />$1,331,933 <br />Total # of Individuals <br />167 <br />180 <br />190 <br />Cost Per Individual <br />$7,528 <br />$7,388 <br />$7,010 <br />PROGRAM INFORMATION 1/22/2018 1:53:42 PM Page 18 of 18 <br />