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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 /> d) Describe the population to be served or the area to benefit and indicate how you will <br /> identify beneficiaries. <br /> The population served through our program is people with physical disabilities. The <br /> area to benefit includes Chapel Hill, Carrboro, and Orange County, as well as other <br /> surrounding Triangle communities. Beneficiaries are identified through the school system, <br /> rehabilitation and specialty medical clinics, and word of mouth. <br /> e) Who specifically will carry out the activities and in what location will they be carried out? <br /> Bridge II Sports certified coaches and staff will carry out the wheelchair basketball, <br /> boccia ball, and adapted sports day programs. Wheelchair basketball is offered in Durham <br /> and Raleigh. Boccia ball is offered in Cary, with the possibility of expansion to Chapel Hill in <br /> the 2016-2017 seasons. Adapted sports days are offered to any public school in the state <br /> of North Carolina, however funding requested in this funding application will go towards <br /> adapted sports days to be offered in Orange County Public Schools or Chapel Hill Carrboro <br /> Public Schools. <br /> f) Describe specifically the period over which the activities will be carried out, the frequency <br /> with which the activities will be carried out, and the frequency with which services will be <br /> delivered. Include an implementation timeline. <br /> Wheelchair basketball: Bi-weekly August 2016-April 2017 <br /> Boccia ball: Weekly August-November 2016, January-April 2017 <br /> Adapted Sports Day: Offered during the school year <br /> g) 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, give specific examples of the coordinated/collaborative efforts. <br /> • The following agencies provide donated play space for the wheelchair basketball <br /> and boccia ball programs: <br /> o Boccia Ball: Chapel Hill Parks and Recreation <br /> o Boccia Ball: Cary Parks and Recreation <br /> o Wheelchair Basketball: Raleigh Parks, Recreation, and Cultural Resources <br /> o Wheelchair Basketball: Braggtown Baptist Church <br /> • Duke and UNC Students: Serve as volunteers to assist with wheelchair basketball <br /> and boccia ball programs <br /> • City of Durham: Funding to help support wheelchair basketball, adaptive cycling, <br /> adaptive archery and adaptive air rifle programs and events. <br /> • Disabled Sports USA — As a member, the cost of insurance is affordable for the <br /> level that we are required to carry due to our venues, athletes and funders. <br /> h) Describe what would happen if requested funding is not awarded at all or if a reduced <br /> allocation is recommended. <br /> Bridge II Sports would not be able to run our programs without the requested funding. <br /> Bridge II Sports is the only organization offering adapted sports for people with physical <br /> disabilities in the Triangle. Without this funding, there would be no opportunities people with <br /> physical disabilities to participate in adapted sports programs. <br /> i) Include any other pertinent information. <br /> Main Application 5/24/2016 9:03:13 AM P of 2 <br />