Orange County NC Website
DocuSign Envelope ID:3B67A5FD-6776-4322-9152-0531CA4BC4BD XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Service Providers - $1267 <br /> Dues - $476 <br /> Fees - $419 <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 program budget divided by the total number of program <br /> individuals in this application. <br /> Actual 2015-16 Estimated 2016-17 Projected 2017-18 <br /> Total Cost of Program $21,293 $18,225 $19,350 <br /> Total # of Individuals 71 75 80 <br /> Cost Per Individual $299.90 $243 $241.88 <br /> DO NOT SUBMIT THIS PAGE 2/8/2017 9:06:10 AM Page 18 of 18 <br />