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DocuSign Envelope ID: C47D73DC -CC50- 4723 - 8253- AE01785E7FAA <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />p) Program Budget <br />1. Submit your program budget. You may complete the provided template (separate As <br />file) or you may submit your own budget file (as long as it contains the same information, <br />in the same format, as requested in the provided template). <br />Program 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 />o 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 />• 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 (CDBG /HOME /etc.) <br />• Private Foundation Grants <br />• Other Revenue <br />Expenditures <br />• Compensation <br />• Rent & Utilities <br />• Supplies & Equipment <br />• Travel & Training <br />• Other Expenses <br />2. Program Budget Detail — Provide description of "other" budget items, not defined. <br />Youth Programs -- Other Expenses <br />• Performance Expense -- $643.81 <br />• Afterschool Arts immersion Transportation -- $2,8160.00 <br />• Office Supplies $104.93 <br />• Depreciation -- $11, 504.45 <br />• Bank charges -- $9,343.26 <br />Agency Budget — Other Expenses <br />• Bank charges and fees -- $25,252 <br />• Depreciation -- $31,094 <br />• Bar supplies -- $16,722 <br />• Gala -- $28,535 <br />• Taxes -- $1,900 <br />• Program expenses -- $31,018 <br />PROGRAM INFORMATION 1/23/2018 1:53:53 PM IT' 9 g _-rr= 1 9 of 2 <br />