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DocuSign Envelope ID: 1007B77C-A009-4AA3-964B-3B03B9585341 <br /> txnibit A-continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency & Program Name: Bridge II Sports Adapted Sports: Wheelchair Basketball, Boccia Ball, <br /> and Adapted Sports Day <br /> As you complete your application, complete only those sections that pertain to the type of <br /> application you are submitting. The application is divided into several sections and not all sections <br /> apply to every project. Every applicant MUST complete the main application. <br /> a) Check the type of funding request for this application package submittal and complete the <br /> required application and required supplemental sections (Parts) as specified below: <br /> ® Human Services (Main Application Only) <br /> ❑ CDBG Non-Construction — (Main Application AND Part A) <br /> ❑ CDBG Construction — (Main Application AND Part A AND Part B) <br /> ❑ HOME CHDO Set-aside — (Main Application AND Part A) <br /> ❑ HOME Other — (Main Application AND Part A AND Part B) <br /> Indicate the type of program for which you are requesting funding: <br /> Program Category Youth Adult Elderly Disabled Public Housing <br /> (not elderly) Neighborhoods/Residents <br /> Education x x x <br /> Health and Nutrition x x x <br /> Job Training <br /> Sports and Arts <br /> Activities x x x <br /> Pre-School Activities <br /> After-School <br /> Activities x x <br /> Mentoring x x x <br /> Transportation <br /> Housing <br /> Other: Please <br /> specify <br /> Main Application 5/24/2016 9:03:13 AM P , 5 of 2 <br />