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DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <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 />See completed Budget Template attached <br />iii. Does your agency budget show a Surplus or Deficit? <br />Surplus in 2016 -2017 budget summaries <br />is there a significant change? Yes /No Yes <br />Please provide a brief explanation for Surplus or Deficit, and significant changes. <br />The surplus amount for the 2016 -2017 budget revenue is due to funders paying out their <br />grant awards early for the 2017 -2018 fiscal year. The 2017 -2018 -year budget includes <br />this revenue. <br />iv. What is your agency's fiscal year? July 1 -- June 30 <br />(Example: July 1, 2096 through June 30, 2097) <br />Agency Information 1122/2018 10:14:21 AM Page 8 of 33 <br />