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DocuSign Envelope ID: 1BB65AEA-3E6A-45BE-8A7F-19FFOF9A712A <br /> EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> p) Program Budget <br /> 1. Submit your program budget. You may complete the provided template (separate As <br /> rile) or you may submit your own budget file (as long as it contains the same information, <br /> in the same format, as requested in the provided template). <br /> Program 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 /> ■ 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 /> 2. Program Budget Detail -- Provide description of"other" budget items, not defined. <br /> Included in the "other" budget item is as follows: <br /> • Administrative costs <br /> • Outreach marketing, PR <br /> • Curriculum development <br /> • Museum exhibit maintenance <br /> • Food <br /> 3. This program budget represents what percent of the agency budget? 3% <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 1 Estimated 2017-18 1 Projected 2018719 <br />