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12 <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: <br /> Program Primary Contact and Title: <br /> Telephone Number: E-Mail: <br /> a) Indicate the type of Human Service Needs Priority, if program applicable: <br /> ❑ Priority Area #1: safety-net services for disadvantaged residents <br /> ❑ Priority Area #2: education, mentorship, and afterschool programming for <br /> youth facing a variety of challenges <br /> ❑ Priority Area #3: programs aimed at improving health and nutrition of needy residents <br /> b) Indicate the type of program for which you are requesting funding <br /> (Check all that apply to this program) <br /> Program Category Youth Adult Elderly Disabled Public Housing <br /> Neighborhoods/Residents <br /> Affordable Housing <br /> Affordable Healthcare <br /> Education <br /> Family Resources <br /> Jobs/Jobs Training <br /> Food <br /> Transportation <br /> Other: Please specify <br /> c) Provide a bulleted list of other agencies, if any, with which your agency <br /> coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s) <br /> to be funded. For each, briefly describe the coordinated/collaborative efforts. <br /> Program Description (3 pages OR LESS) <br /> Please provide the following information about the proposed program: <br /> d) Summarize the program services proposed and how the program will address a <br /> Town/County priority/goal? <br /> e) Describe the community need or problem to be addressed in relation to the Chapel Hill <br /> Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of <br /> Chapel Hill Council Goals, Carrboro goals, or other community priorities (i.e. Council/Board <br /> Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services <br /> Needs Assessment) to support the need for this program. <br /> ATTACHMENTS 9/16/2016 12:39:24 PM Page 1 1 of 1 7 <br />