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DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />o. Program Budget <br />5. Submit your program budget. You may complete the provided template (separate As <br />file) or you may submit your own budget file (as long as it contains the same information, <br />in the same format, as requested in the provided template). <br />Program 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 />o 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 />o Other Government Grants <br />• Triangle United Way <br />• State Government <br />• Federal Government (CDBG /HOME /etc.) <br />• Private Foundation Grants <br />o Other Revenue <br />Expenditures <br />• Compensation <br />• Rent & Utilities <br />• Supplies & Equipment <br />• Travel & Training <br />• Other Expenses <br />6. Program Budget Detail — Provide description of "other" budget items, not defined. <br />To meet community programming needs and stay open, the museum is forced to draw on its reserve <br />funds, which are running out. Over the past ten years the museum has augmented its operational <br />budget by $129,482. Without additional government and NGO support, the museum only has <br />enough funds for two to three years of operation before closing. <br />7. This program budget represents what percent of the agency budget? 10.9% <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 1/23/2018 12:14:22 PM P a g e 30 cu i 4 <br />Actual 2016 -17 <br />Estimated 2017 -18 <br />Projected 2018 -19 <br />Total Cost of Program <br />$6,937 <br />$7646 <br />$7657 <br />Total # of Individuals <br />1248 <br />1823 <br />2000 <br />Cost Per Individual <br />$5.55 <br />$4.19 <br />$3.83 <br />PROGRAM INFORMATION 1/23/2018 12:14:22 PM P a g e 30 cu i 4 <br />