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DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> • Charles House, <br /> • Child Care Services Association of Chapel Hill, <br /> • Club Nova, <br /> • Community Nutrition Partnership, <br /> • Friends of the DSS, <br /> • Human Rights Center of Carrboro and Chapel Hill, <br /> • IFC, <br /> • Meals on Wheels of Chapel Hill, <br /> • PORCH, and <br /> • TABLE. <br /> h) Describe what would happen if requested funding is not awarded at all or if a reduced <br /> allocation is recommended. <br /> Less funding results in less healthy produce for each of the above agencies and the people they <br /> serve. <br /> i) Include any other pertinent information. <br /> Farmer Foodshare works collaboratively in all our efforts to end hunger and food <br /> insecurity. By working with agencies within the community to distribute fresh produce to <br /> their networks of individual in need, we are able to support and enhance existing efforts, <br /> while keeping overhead costs low. Additionally, we have regular dialogue with our partners <br /> to provide support like recipes and fresh food safety information and help in sourcing the <br /> right kinds of produce in the right amounts. When requested, we connect with our partner <br /> agencies to provide cooking demonstrations and provide volunteers to help with food prep <br /> and packing. We also provide support in purchasing cold storage. <br /> Program/Project Information <br /> j) Complete the Target Population and Program Beneficiary Demographics Chart <br /> k) Complete the Schedule of Positions Chart for Program Staff <br /> I) Disclosure of Potential Conflicts of Interested must be signed <br /> m) Complete the Work Statement Chart to describe the work to be performed, and be sure to <br /> attach copies of all data collection tools that will be used to verify achievement of program <br /> goals and objectives. Describe who will be responsible for monitoring progress. <br /> Information to Complete <br /> j.) Target Population <br /> Complete the following tables to the best of your ability. Show numbers of participants and <br /> percentages, as applicable, in each category. <br /> Please indicate whether this project/program will serve: x❑ Persons ❑ Households ❑ Units <br /> Because we supply goods to agencies,we rely <br /> on each agency's report of individual <br /> participants. <br /> Program: Farmer Foodshare Donation Stations <br /> Program Beneficiary Demographics <br /> Main Application 5/25/2016 8:50:30 AM Pag of 1 <br />