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DocuSign Envelope ID:380F50AD-C98D-426B-80DC-9Al34EB8DA24 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <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 /> iii. Does your agency budget show a Surplus or Deficit? Small Surplus <br /> Is there a significant change? Yes/No No <br /> Please provide a brief explanation for Surplus or Deficit, and significant changes. <br /> We are working on building a Reserve for the organization, so we have created a line <br /> item during these fiscal years for a reserve. <br /> iv. What is your agency's fiscal year? January 2017-December 2017 <br /> (Example: July 1, 2016 through June 30, 2017) <br /> Agency Information 1/31/2017 3:02:18 PM Page 10 of 18 <br />