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PROGRAM INFORMATION8/31/2018 11:35:08 AM Page 7 of 11 <br />d)Agency Budget (See Excel Spreadsheet) <br />i.Is your agency currently receiving and/or requesting otherlocalgovernment <br />funding?(Yes/No)No <br />If yes, please list below: <br />Program FY17-18 <br />Award <br />FY18-19 <br />Request <br />Source <br />Ex: Affordable Rental <br />Rehabilitation <br />0 $20,000 Carrboro -Affordable Housing <br />Ex: Agency Administration $15,000 $15,000 Chapel Hill -Other <br />Ex.Total $15,000 $35,000 Total Funding <br />*Add rows or attach additional page, if needed. <br />ii.Submit your agency’s budget. You may complete the provided template (separate <br />xls file) or you may submit your own budget file (as longas it contains the same <br />information, and in a similar format, asrequested in the provided template). <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 />Exhibit A <br />Provider's Cardinal Managed Care Application and Work Statement <br />DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11