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PROGRAM INFORMATION2/9/2017 4:13:51 PM Page 19 of 22 <br />n)Program Budget <br />1.Submit your programbudget.You may complete the provided template (separate xls <br />file) or you may submit your own budget file (as long as it contains the same information, <br />in the same format, asrequested 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 />x Revenues <br />o Private Donations <br />o Program Generated Revenue <br />o 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 NOTInclude HOME funding here) <br />o 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 />x 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 />3.This program budget represents what percent of the agency budget? 71% <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 />Actual 2015-16 Estimated 2016-17 Projected 2017-18 <br />Total Cost of Program7,127.00$15,899.50$16,281.50 <br />Total # of Individuals52727 <br />Cost Per Individual1018.90$588.87$603.02 <br />EXHIBIT A <br />PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3