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DocuSign Envelope ID:C4C09F35-022B-45DE-8313-4A1ED7AF458B XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <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? (Yes/No) Yes <br /> If yes, please list below: <br /> Include all programs that have funding requests/awards/totals from Carrboro, Chapel Hill, <br /> and Orange County governments (other than Human Services). DO NOT include federal <br /> funding sources, such as CDBG and HOME. <br /> Program FYI 6-17 FYI 7-18 Source <br /> Award Request <br /> 10 x 10 Play Festival $4,000 $4,000 Carrboro Tourism Development Auth. <br /> Elf Fair $1,000 $1,000 Carrboro Tourism Development Auth. <br /> Total Other Carrboro Funding 5,000 $5,000 <br /> Artist in Residence-Title 1 schools 15,000 $5,000 Orange County Schools <br /> 10x10 Play Festival $1,500 Orange County Arts Commission <br /> Summer Camp Artists support $1,000 Orange County Arts Commission <br /> Grady Brown Artist in Residence $5,000 Orange County Arts Commission <br /> Title 1 School addition in 17-18 <br /> Total Other Orange County $17,500 $10,000 <br /> *Add rows or attach additional page, if needed. <br /> ii. Submit your agency's budget. (See Attached) <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 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 /> 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 /> • Expenditures <br /> o Compensation <br /> o Rent & Utilities <br /> o Supplies & Equipment <br /> o Travel & Training <br /> o Other Expenses <br /> Agency Information 2/8/2017 5:24:23 PM Page 10 of 20 <br />