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DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />PROGRAM NAME <br />PROGRAM REVENUE <br />Private Donations <br />Program Budget <br />Operating Budget for Program <br />Preservation and Research <br />Program Generated Revenue <br />Local Government Grants: <br />Human Services - Town of Carrboro <br />Other - Town of Carrboro <br />Human Services - Town of Chapel Hill <br />Other - Town of Chapel Hill <br />Human Services - Orange County <br />Other - Orange County <br />Other - Town of Hillsborough <br />Other Government Grants <br />Triangle United Way <br />State Government <br />Federal Government (CDBG /HOME /etc.) <br />Private Foundation Grants <br />Other Revenue <br />Total Program Revenue <br />PROGRAM EXPENSES <br />Compensation <br />Rent & Utilities <br />Supplies & Equipment <br />Travel & Training <br />Other Expenses: <br />Total Program Expenses <br />SURPLUS /(DEFICIT) FOR PERIOD: <br />FY 2018 -19 Program Budget <br />$ - 1 $ - 1 $ - 1 0 <br />Actual <br />2016 -17 <br />Estimated <br />2017 -18 <br />Projected <br />2018 -19 <br />Percent <br />Change <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />2,000 <br />$ <br />2,000 <br />$ <br />- <br />-100% <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />1,100 <br />$ <br />1,449 <br />$ <br />388 <br />-73% <br />$ <br />- <br />1 $ <br />- <br />1 $ <br />- <br />0 <br />$ <br />1,995 <br />$ <br />1,000 <br />$ <br />6,383 <br />538% <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />t$M1,576 <br />$ <br />2,322 <br />$ <br />- <br />$ (1.00) <br />$ <br />6,671 <br />$6,371 <br />$ <br />$ <br />6,771 <br />6,371 <br />$ <br />$ <br />6,771 <br />6,371 <br />0% <br />0% <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />330 <br />$ <br />400 <br />$ <br />400 <br />0% <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />6,671 <br />$ <br />6,771 <br />$ <br />6,771 <br />0% <br />$ - 1 $ - 1 $ - 1 0 <br />