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DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />h) Agency Budget <br />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? fYes /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 e Counf governments (other than Human Services). DO NOT include federal <br />funding sources, such as CDBG and HOME. <br />Program <br />FY17 -18 <br />Award <br />FY18 -19 <br />Request <br />Source <br />Ex: Affordable Rental <br />Rehabilitation <br />0 <br />$20,000 <br />Carrboro - Affordable Housing <br />Ex: Agency Administration <br />$15,000 <br />$15,000 <br />Carrboro -- Other <br />Ex. Total <br />$15,000 <br />$35,000 <br />Carrboro Total Funding <br />NIA <br />`Add rows or attach additional page, if needed. <br />Agency information 1/22/2018 10:14:21 AM Flags 7 of <br />