Orange County NC Website
Browse       Search
DocuSign Envelope ID:A3E0213B-1DCD-43A3-9C41-A2EC55A8CA94 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency & Program Name: Orange Congregations in Mission, Samaritan Relief Ministry <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 <br /> Health and Nutrition <br /> Food Pantry ✓ ✓ ✓ ✓ <br /> Job Training <br /> Sports and Arts <br /> Activities <br /> Pre-School Activities <br /> After-School <br /> Activities <br /> Mentoring <br /> Transportation <br /> Housing <br /> Other: Please <br /> specify Rent, Utility <br /> assistance <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 chosen <br /> Town/County priority? <br /> Only applying for county funds. <br /> Main Application 5/25/2016 9:39:17 AM P 6 of 22 <br />