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DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued <br /> Provider's kt dx elrGA I I lication <br /> 1. COVER PAGE (Each program requires a separate application.) <br /> a) Applicant Contact Information <br /> Applicant Organization's Legal Name: Behavioral Insights, Inc. <br /> Applicant Organization's Physical Address: 100 N. Churton Street, Ste. 207, Hillsborough, NC <br /> 27278 <br /> Applicant Organization's Mailing Address: 100 N. Churton Street, Ste. 207, Hillsborough, NC 27278 <br /> Applicant Organization's Web Address: www. DVclassesorangenc.org (under development) <br /> Executive Director: Joyce Kuhn <br /> Telephone Number: 919 245-3310 E-Mail: kuhnjoyce @gmail.com <br /> DUNS Number: 07-871-8903 <br /> (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) <br /> b) Proiect/Program Contact Information <br /> Project/Program Name: Sentencing Plan Service <br /> Project/Program Primary Contact and Title: Joyce Kuhn Executive Director <br /> Telephone Number: (919) 245-3310 E-Mail: kuhnjoyce @gmail.com <br /> c) Funding Request Identification <br /> Total Project/Program Cost: $18,000 Total Amount of Funds Requested: $$18,000 <br /> Proposed Use of Funds Requested (2-3 Line Maximum): to continue to provide sentencing expert <br /> services (written bio-psycho-social plans with links to program referrals to match risk (for recidivism) <br /> areas of that individual offender. The cost of preparing these plans is reimbursed in part by the AOC <br /> —state funding, $500 per plan. To accommodate fluctuations in referrals staff and contractors <br /> prepare them. <br /> Please check all types, sources, and amounts of funding being requested. You must submit an <br /> application package for each funding source. *The Participating Jurisdiction reserves the right to <br /> fund projects from any funding source, subject to eligibility and funding constraints. <br /> ❑ CDBG Non-Construction (CH) $ ❑ Grant ❑ Loan <br /> ❑ CDBG Construction (CH) $ ❑ Grant ❑ Loan <br /> ❑ HOME CHDO (OC) $ C Grant [' Loan <br /> n HOME Other (OC) $ ❑ Grant ❑ Loan <br /> XEI Human Services: X❑ Carrboro $6,000 X❑ Chapel Hill $$8,000 ❑ Orange <br /> County $4,000 <br /> d) To the best of my knowledge and belief all information and data in this application is <br /> true and current. The document has been duly authorized by the governing board of the <br /> applicant. <br /> Main Application 1/20/2016 4:35:53 PM Page 3 of 21 <br />