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DocuSign Envelope ID: E30588DE -A1 BC- 443D- A5C4- 3BE790331500 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <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 />• 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 />o Compensation <br />o Rent & Utilities <br />o Supplies & Equipment <br />o Travel & Training <br />o Other Expenses <br />iii. Does your agency budget show a Surplus or Deficit? Breakeven — No Surplus or <br />Deficit <br />Is there a significant change? Yes /No No <br />Please provide a brief explanation for Surplus or Deficit, and significant changes. <br />Our 2018 budget is a breakeven budget, indicating that we intend to generate <br />revenue and appropriately use funding to serve the needs of the disabled <br />community. <br />iv. What is your agency's fiscal year? January 1, 2018 — December 31, 2018 <br />(Example: July 1, 2016 through June 30, 2097) <br />Agency Information 1/22/2018 10:12:15 AM Page 11 of 30 <br />