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DocuSign Envelope ID: 913F749B-B9E8-4103-AF9D-A4296D01069E t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> network of agencies that make referrals), the fact that we receive grant money also allows us to <br /> keep our rates low, which allows us to keep our paying population diverse. It is out intention to <br /> remain in Orange Country (Chapel Hill) indefinitely serving JCPC referred and funded kids. At <br /> $20,000 JCPC remains our largest fuding source. This year Chapel Hill decided NOT to fund us for <br /> the first time, Carrboro continued to fund us, and Orange County decided TO fund us for the first <br /> time. <br /> In regards to Chapel Hill, we certainly understand the high demand for these funds, but these <br /> smaller pots of money lend credence to or work and efforts that help ensure that JCPC continues to <br /> fund us. This year, we would appeal to Carrboro and Orange County NOT to follow Chapel Hill's <br /> last year's decision, and we would like to appeal to Chapel Hill to resume their support of us as <br /> before. Doing so, keeping our funding streams diverse, plays a critical role in ensuring that the <br /> entire funding package (including JCPC) remains intact. We intend to remain in Chapel Hill <br /> indefinitely, but one possible outcome for us, should we at some point in the future lose the JCPC <br /> funding, would be that we would have to raise our rates, thus potentially pushing out the kids that <br /> need us most. Please understand that we DO seek financial independence, but to lower our support <br /> this early in our development, in Chapel Hill after all, would be to threaten out longevity as an entity <br /> that remains diverse and open to kids who can't afford to pay. <br /> I) Include any other pertinent information. <br /> Two years ago we were notified that the NC Department of Public Safety would end funding for our <br /> Young Warriors Cognitive Behavior Therapy Program. starting July 1st, 2014.(Although this program <br /> shares the name "Young Warriors" in common, it was a different program offering therapy to court- <br /> referred youth.) We had received this funding $45,000/year for 3 years and the loss (which is no <br /> fault of ours; NC is changing the way this fund base is allocated) was a devastating blow to our <br /> overall agency budget, hence endangering this Young Warriors Program as well. As a result, we <br /> have been working hard to identify alternative funds, and are clearly having to turn to a larger <br /> number of grant makers, each which typically award much smaller amounts of money. Our <br /> projected program budget and agency budget look strong on paper but we expect that several of <br /> our requests will be funded to amounts less than requested, rendering each one of these requests <br /> (Orange County, Carrboro and Chapel Hill) all the more vital. <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 /> Main Application 1/25/2016 10:16:09 AM Page 9 of 20 <br />