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DocuSign Envelope ID: A899BE5E- BAAEC- 40F3 -91 E1- A9D77FC4C488 <br />p) Program 13E u "dgeIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />5. Submit your program budget. <br />See attached <br />6. Program Budget Detail — Provide description of "other" budget items, not defined. <br />Other Line items include contracted services, communications, printing and copying, <br />community training, dues and subscriptions, participant incentives <br />7. This program budget represents what percent of the agency budget? 30% <br />8. COST PER INDIVIDUAL <br />This Cost per individual must reflect the total program budget divided by the total number of <br />program individuals in this application. <br />PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page '24 o f 33 <br />Actual 2016 -'17 <br />Estimated 2017 -18 <br />Projected 2018 -19 _. <br />Total Cost of Program <br />$240,271 <br />$398,477 <br />$408572 <br />Total # of Individuals <br />1739 X383 +'144 = <br />1350f500� 85= <br />1500 500.100= <br />(totals for all three initiatives <br />2256 <br />1935 min <br />2100 min <br />resented in grant application) <br />Cost Per Individual <br />$108 <br />$205 <br />$195 <br />PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page '24 o f 33 <br />