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DocuSign Envelope ID: E30588DE -A1 BC- 443D- A5C4- 3BE790331500 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />h) Agency Budget <br />i. Is your agency currently receiving and/or requesting other (non -Human Services) <br />local (Town of Carrboro, Town of Chapel Hill, Orange County) government <br />funding? (Yes /No) No <br />If yes, please list below: <br />Include all programs that have funding requests /awards /totals from Carrboro Chapel Hill, <br />and Oran a Count governments (other than Human Services). DO NOT include federal <br />funding sources, such as CDBG and HOME. <br />Program <br />FYI 7-18 <br />Award <br />FYI 8-19 <br />Request <br />Source <br />Ex: Affordable Rental <br />Rehabilitation:,: <br />0 <br />$20,000 <br />Carrboro:- Affoidable Housing <br />Ex: Agency Administration <br />$15,000 <br />$15,000` <br />Carrboro .Other <br />Ex. Total <br />$151000 <br />$35,000" <br />Carrboro Total "Funding <br />*Add rows or attach additional page, if needed. <br />ii. Submit your agency's budget. You may complete the provided template (separate <br />As file) or you may submit your own budget file (as long as it contains the same <br />information, and in a similar format, as requested in the provided template). <br />Please see attachment BIIS Agency Budget for our entire agency budget. Please <br />refer to attachment BIIS Budget Worksheets 2018 -2019 for the Revenue portion <br />of our Agency Budget to include funds received from Carrboro, Chapel Hill and <br />Orange County Human Services. <br />.... ............................... <br />Agency Information 1/22/2018 10:12:15 AM Page 10 of 30 <br />