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DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <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 (CDBGIHOMEIetc.) <br />• Private Foundation Grants <br />• Other Revenue <br />• Expenditures <br />Q Compensation <br />o Rent & Utilities <br />* Supplies & Equipment <br />o Travel & Training <br />o Other Expenses <br />iii. Does your agency budget show a Surplus or Deficit? Surplus <br />Is there a significant change? Yes /No Yes <br />Please provide a brief explanation for Surplus or Deficit, and significant changes. <br />Expansion of programming to additional counties through a state - approved contract has <br />added to our expenses and revenue. <br />iv. What is your agency's fiscal year? October 1, 2018- September 30, 2018 <br />(Example: July 9, 2016 through June 30, 2017) <br />Agency Information 1122/2018 1 :39:57 PM Page 13 of 26 <br />