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DocuSign Envelope ID: EBOFBDBE -FD15- 4428 - 8998- 19A867F94OCC <br />h) Agency Budget <br />i. Is your agency currently receiving and/or requesting other (non - Human. Services) <br />local (Town of Carrboro, Town of Chapel Hill, Orange County) government <br />funding? (YeslNo) No <br />If yes, please list below: <br />Include aH programs that have funding requestslawards/totals from Carrboro Chapel Hill <br />and Qmgge Counh► governments (other than Human Services). DO NOT include federal <br />funding sources, such as GDBG and HOME. <br />Program <br />FY1748 <br />Award <br />FY18 -19 <br />Request <br />Source <br />Ex. Affordable Rental <br />Rehabilitation <br />0 <br />$20,000 <br />Carrboro - Affordable Housing <br />Ex- Agency Administration <br />$75,000 <br />$75,000 <br />Carrboro -- Other <br />Ex. Total <br />$15,000 <br />$35,000 <br />Carrboro Total Funding <br />*Add rows or attach additional page, if needed. <br />ii. Submit your agency's budget. You may complete the provided template (separate <br />x!s file) or you may submit your own budget file (as long as it contains the same <br />information, and in a similar format, as requested in the provided template), <br />Agency 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 />o Program Generated Revenue <br />o Local Government Grants <br />• Carrboro Human Services <br />• Carrboro Other <br />• Chapel /-fill Human Services <br />• Chapel Hill Other (DO NOT include CDBG funding here) <br />❑rwnril Whrmatinn 717'41an1R R•a .q =u ASIA p p ri n 1 1 o f 9 <br />