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DocuSign Envelope ID:636AFD33-DA5C-4B55-88DC-03C0863BAFE3 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency & Program Name: Mental Health America of the Triangle– Family Advocacy Network <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 /> X 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 <br /> Job Training <br /> Sports and Arts <br /> Activities <br /> Pre-School Activities <br /> After-School <br /> Activities <br /> Mentoring/Ongoing <br /> Friendship X X X <br /> Transportation <br /> Housing <br /> Other: Please <br /> specify– Parenting <br /> Skills Building and <br /> Parent Advocacy X X X <br /> Program/Project Description (Label your responses as outlined below; not to exceed 3 pages.) <br /> Please provide the following information about the proposed program/project: <br /> b) Summarize the program services proposed and how the program will address the <br /> chosen Town/County priority? <br /> FAN's staff are trained, professional Family Advocates, who are themselves parents of <br /> special needs children. They provide services to other parents, including: supportive <br /> counseling, developing family strengths, parenting skills building, parent education <br /> workshops and navigation support for accessing needed mental health treatment, special <br /> Main Application 5/25/2016 9:20:28 AM P 6 of 20 <br />