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3 <br /> Orange County Partnership for Young Children <br /> Second Round Smart Start Grants <br /> APPLICATION COVER PAGE <br /> Grant Applying For: Planning Grant <br /> (1. Facilities Improvement; 2. Equipment&Program Improvements;-3. Planning Grant; 4. Services Grant.) <br /> Name/Agency: Orange County Health Department - <br /> Address: P . 0 . Box 8181 <br /> City, State, Zip: Hillsborough , NC 27278 <br /> Contact Person: Eileen Kugler Telephone: 967-9251 ext . 2401 <br /> Signature of Applicant:_ --- Title: <br /> For Child Care Providers Only: Type of DayCare: Check all that apply <br /> ( ) "A" Licensed Large Home ( ) "A" Licensed Center <br /> ( ) "AA" Licensed Large Home ( ) "AA" LicensedCenter <br /> ( ) NAEYC Accredited Center <br /> ( ) Registered Day Care Home ( )NAFDC Accredited Home <br /> ( ) Unregulated Preschool Program ( ) Unregulated Home <br /> For all other agencies or individuals: Check One <br /> ( x) Public Government Institution ( ) Private for profit agency <br /> ( ) 501 (c)(3) Non profit with tax exempt status ( ) Private individual , <br /> ( ) Applied for non profit status ( ) Other <br /> ( ) Sponsored by a 501 (c)(3) Organization <br /> Do you currently provide programs and/or services for-children under <br /> age five or their families in Orange County? (x ) Yes ( ) No <br /> Do you currently serve a large percentage of low-income or special <br /> needs children? (x ) Yes ( ) No <br /> Check which Partnership Vision Goal(s) Your Project Addresses: <br /> ( ) Improve Child Care Services. <br /> ( � Increase access to health services for young children and their families. <br /> ( X) Develop and enhance family support and education services. <br /> ( � Improve and enhance mental health and early intervention for young children and <br /> their families. <br /> ( ) Provide economic support programs for low income families. <br /> ( � Insure that all young children are safe from violence. <br /> ( � Improve the delivery of human services for young children and their families. <br /> ( ) Educate and enlighten the community about the value of early services for <br />