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DocuSign Envelope ID: 717C8AE2- 4D6E- 4E46- A9A7- F4213973D039 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />ii. Submit your agency's budget. You may complete the provided template (separate <br />xis 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 />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 (CDBG /HOME /etc.) <br />• Private Foundation Grants <br />• Other Revenue <br />Expenditures <br />• Compensation <br />• Rent & Utilities <br />• Supplies & Equipment <br />• Travel & Training <br />• Other Expenses <br />iii. Does your agency budget show a Surplus or Deficit? Yes <br />Is there a significant change? Yes /No No <br />Please provide a brief explanation for Surplus or Deficit, and significant changes. <br />As seen in the budget worksheet, the surplus for actual, estimated and projected are <br />minimal. Last year's actuals had a surplus of $34,951 due to 2 unapplied for grants and 1 <br />unexpected gift.. <br />iv. What is your agency's fiscal year? July 1, 2018 through June 30, 2019 <br />(Example: July 1, 2016 through June 30, 2017) <br />Agency Information 1123/2018 1 :58:29 PM P a g e 1 3 o f 3 11 <br />