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DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />PROGRAM NAME <br />PROGRAM REVF -NUE <br />Private Donations <br />Program Budget <br />Operating Budget for Program <br />Refugee Support Center <br />Program Generated Revenue <br />Local. Government Grants: <br />Hinman Services - Town of Carrharo <br />Other - Town of CanWro <br />Human Services - Town of Chapel Hill <br />Other - Town of Chapel Hill <br />Human Services - Orange County <br />Other - Orange County <br />Other - Town of HillsLcrough <br />Other Government Grants <br />Triangle United Way <br />State Government <br />Federal Government (CDBG /HOMFJetc_) <br />Private Foundation Grants <br />Other Revenue <br />Total Program Revenue <br />PROGRAM EXPENSES <br />Compensation <br />Rent & Utilities <br />Supplies & Equipment <br />Travel & Training <br />Other Expenses: Insurrnre <br />Total Program Expenses <br />SURPLUSJ(I]EFICIT} FOR PERIOD <br />FY 2018 -19 Program Budget <br />Actual <br />2016-17 <br />sti hate <br />2017 -18 <br />relectec <br />2018 -19 <br />Percern <br />Change <br />$ - <br />h <br />- <br />$ <br />0 <br />0 <br />$ - <br />$ <br />11,340 <br />$ <br />- <br />- 100% <br />0 <br />0 <br />0 <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />S - <br />$ <br />- <br />$ <br />- <br />0 <br />0 <br />S - <br />11,340 <br />S <br />17,000 <br />500% <br />$ - <br />$ <br />11,340 <br />$ <br />13,00D <br />15% <br />S - <br />11 10 <br />S <br />17.000 <br />50% <br />PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 26 of 26 <br />