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DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. This program budget represents what percent of the agency budget? 100% <br /> 4. COST PER INDIVIDUAL <br /> This Cost per Individual must reflect the total programs budget divided by the total number of <br /> program individuals in this application. <br /> ,Actual 2018-17 Estimated 2017-18 Projected 2018-19 <br /> Total Cost of Program 285,898 332,807 331,496 <br /> Total# of Individuals 1094 1250 1250 <br /> Cost Per Individual 243 286 265 <br /> We define "# of individuals" in terms of weighted Units of Service. <br /> UNIT OF SERVICE: reflects the services each student receives in terms of 1:1 time with <br /> the licensed clinical staff, 'dosage' of services they receive with guest speakers, group <br /> sessions and academic engagement (tutoring, communicating with teachers, follow-up <br /> support), as well as after school programming (community service, service learning, What's <br /> Next?, drop-in brief crisis counseling, schoolwork help). <br /> 2016-17 <br /> 2-4 day ATS = 1 unit of service = 126 units <br /> 5-7 day ATS = 2 units of service = 27x2 = 54 units <br /> 8-10 day ATS = 3 units of service = 28x3 = 84 units <br /> Instances of students working on service projects = 1 unit of service = 381 units <br /> Students receiving intensive follow-up services = 3 units of service = 12x3 = 36 units <br /> Instances of students attending What's Next? = 1 unit of service = 231 units <br /> Instances of students receiving after school tutoring = 2 units of service = 8x2 = 16 units <br /> Student attending Open Doors (drop in, brief crisis counseling) = 1 unit of service = 156 units <br /> PROGRAM INFORMATION P a g e 1 7 o f 2 0 <br />