2018-472-E Finance - Pathways to Change outside agency agreement

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DocuSign Envelope ID: 74839431 - 9216- 429F- BFA4- 2AC6473BD9D3 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION P) Program Budget 1. Submit your program budget. You may complete the provided template (separate xis file) or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template), Program Budgets are required to define Budget amounts for the previous program year, current program year, and next program year for the following categories: Revenues • Private Donations • Program Generated Revenue • Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding Mere) • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) • Other Government Grants • Triangle United Way • State Government • Federal Government (CDBGIHOMEIetc.) • Private Foundation Grants • Other Revenue Expenditures • Compensation • Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses 2. Program Budget Detail — Provide description of "other" budget items, not defined. Expenses listed in the "Other" category include compensation for contract facilitators to plan and facilitate sessions as well as engage in twice- monthly supervision phone calls with a Batterer Intervention Program consultant to ensure high duality of service. 3. This program budget represents what percent of the agency budget's 35% 4. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. Actual 2016 -17 Estimated 2017 -18 1 Projected 2018 -19 Total Cost of Program ` $10,883 $18,990 $20,760 Total ## of Individuals 3 44 44 Cost Per Individual $3627 $431 $472 PROGRAM INFORMATION 1123/2018 11:18-32 AM Page 20 of 30