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DocuSign Envelope ID:9F461F1C-C86C-42DC-B78C-50FC18D204DF <br /> EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 2. Program Budget Detail — Provide description of "other" budget items, not defined. <br /> Advertising, printing, postage/shipping, IT/technology, telephone/internet, office equipment <br /> lease, office supplies <br /> 3. This program budget represents what percent of the agency budget? 7% <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 87,328 78,165 73,140 <br /> Total #of Individuals 106 129 130 <br /> Cost Per Individual $824/yr $606/yr $563/yr <br /> PROGRAM INFORMATION 1/20/2018 3:58:40 PM Page 21 of 24 <br />