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DocuSign Envelope ID: C47D73DC -CC50- 4723 - 8253- AE01785E7FAA <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />h) Agency Budget <br />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 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 />Presented Season Promotion <br />$5,000 <br />$5,000 <br />Carrboro Tourism Development Auth. <br />Elf Fair <br />$1,000 <br />$1,000 <br />Carrboro Tourism Development Auth. <br />Total other Carrboro Funding <br />$5,000 <br />$6,000 <br />Artist in Residence — Title 1 <br />Schools <br />$5,000 <br />$5,000 <br />Orange County Schools <br />Grady — Brown Artist in Residence <br />Title 1 School Addition 17 -18 <br />$5,000 <br />$5,000 <br />Orange County Schools <br />ArtSparks Family Programing <br />$5000 <br />$5000 <br />Orange County Arts Commission <br />Total Other Orange County <br />$15,000 <br />$15,000 <br />*Add rows or attach additional page, if needed. <br />ii. Submit your agency's budget. You may complete the provided template (separate <br />As 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 />• Private Donations <br />• Program Generated Revenue <br />• Local Government Grants <br />• Carrboro Human Services <br />• Carrboro Other <br />• Chapel Hill Human Services <br />• Chapel Hill Other (DO NOT include CDBG funding here) <br />Agency Information 1/23/2018 1:53:53 PM Page 11 of <br />