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Seminars/Conferences 50%-$1,500 evidence-based training program <br />50%-$600 SHIFT Conference <br />$1,050 <br />Refreshments $7 each x 15 participants x 12 sessions; $7 each x 10 participants x <br />10 sessions; Alumni –$50 x 12 sessions; Graduations -$350; <br />Workshops -$215 <br />$3,125 <br />Program Supplies Community outreach (condoms, lubricants, etc) -$2/item x 250 <br />($500); education brochures -$2/item x 100 ($200); swag for <br />tabling events (buttons, cups, stickers) $0.50/item x 500 ($250) <br />$950 <br />Peer Assistant $160 <br />Telephone $50/month x 12 x 50%$300 <br />Facilities Allocation $567/month x 12 x 50%$3,402 <br />IT Allocation $127/month x 12 x 50%$760 <br />3.This program budget represents what percent of the agency budget? 0.2% <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 2016-17 Estimated 2017-18 Projected 2018-19 <br />Total Cost of Program 39,868 45,508 46,286 <br />Total # of Individuals 379 363 363 <br />Cost Per Individual $105.19 $125.37 $127.51 <br />● The cost per individual is lower in FY17 because there was a period of time, after <br />programs were completed, when we did not have a community health educator. <br /> <br />Exhibit A: Provider's Outside Agency Application <br />DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E