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DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />ee) Program Budget <br />9. 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 />o 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 />o Other Revenue <br />Expenditures <br />o Compensation <br />o Rent & Utilities <br />• Supplies & Equipment <br />• Travel & Training <br />• Other Expenses <br />10. Program Budget Detail — Provide description of "other" budget items, not defined. <br />11. This program budget represents what percent of the agency budget? 9.6% <br />12. 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 <br />Actual 2016 -17 <br />Estimated 2017 -18 <br />Projected 2018 -19 <br />Total Cost of Program <br />$6701 <br />$6771 <br />$6771 <br />Total # of Individuals <br />27 <br />30 <br />35 <br />Cost Per Individual <br />$248.18 <br />$225.70 <br />$193.45 <br />PROGRAM INFORMATION 1/23/2018 12:14:22 PM <br />