Orange County NC Website
Browse       Search
DocuSign Envelope ID: 28872B9E- 993A- 44CA- 8A5E- OBDA1F6178CB <br />Exhibit A: Provider's Outside Agency Application <br />c) Program Budget <br />1. 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 />• 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 (CDBGfHOMEletc.) <br />• Private Foundation Grants <br />• Other Revenue <br />• Expenditures <br />o Compensation <br />o Rent & Utilities <br />o Supplies & Equipment <br />o Travel & Training <br />o Other Expenses <br />2. Program Budget Detail — Provide description of "other" budget items, not defined. <br />& This program budget represents what percent of the agency budget? % <br />4. 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 1/29/2018 3:34:15 PM P .1 � 7 C, f <br />Actual 2015 -16 <br />Estimated 20116 -17 <br />Projected 2017 -18 <br />Total Cost of Program <br />$1,600.00 <br />$1,600.00 <br />$1,600.00 <br />Total # of Individuals <br />1 7 <br />7 <br />7 <br />Cost Per Individual <br />$228.00 <br />$225.00 <br />$228.00 <br />PROGRAM INFORMATION 1/29/2018 3:34:15 PM P .1 � 7 C, f <br />