Orange County NC Website
DocuSign Envelope ID: 4B292955- 9A36- 47C6- BDDE- 4E9CDOBA074D <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <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 1/19/2018 3:12:19 PM Page 2 2 of 25 <br />Total Cost of Program <br />257,907 <br />261,552 <br />316,060 <br />Total # of Individuals <br />154 <br />160 <br />180 <br />Cost Per Individual <br />$1,675 <br />$1,634 <br />$1,756 <br />PROGRAM INFORMATION 1/19/2018 3:12:19 PM Page 2 2 of 25 <br />