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DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency & Program Name: Chapel Hill Training Outreach Project, Inc./KidSCope <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 /> application and supplemental application sections as specified below: <br /> ® Human Services (Main Application Only) <br /> ❑ AH Non-Construction (Main Application Only) <br /> ❑ AH Construction — (Main Application AND Part B) <br /> ❑ AHDR Non-Construction (Main Application Only) <br /> ❑ AHDR Construction — (Main Application AND Part B) <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 Parts 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 <br /> Health and Nutrition <br /> Job Training <br /> Sports and Arts <br /> Activities <br /> Pre-School Activities x <br /> After-School <br /> Activities <br /> Mentoring <br /> Transportation <br /> Housing <br /> Other: <br /> Proaram/Proiect 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 chosen <br /> Town/County priority? <br /> KidSCope proposes the following services: <br /> • customized assessment and evaluation for children birth to 5 to determine strengths and needs, <br /> • social-emotional health services using evidence-based modalities, including Parent Child <br /> Interactive Therapy and Child Parent Psychotherapy, <br /> Main Application 5/25/2016 9:13:32 AM .. g 6 of 23 <br />