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DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency & Program Name: Historical Foundation of Hillsborough and Orange County-Orange <br /> County Historical Museum Heritage Education, Programs, Community Workshops, Exhibits, <br /> Collections <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 X X X <br /> Health and Nutrition <br /> Job Training <br /> Sports and Arts <br /> Activities X X X X <br /> Pre-School Activities <br /> After-School <br /> Activities X X <br /> Mentoring <br /> Transportation <br /> Housing <br /> Other: Please <br /> specify <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 /> c) Describe the local need or problem to be addressed in relation to the Consolidated Plan or <br /> other community priorities (i.e. Council/Board Goals). Cite local data to support the need <br /> for this program and the population being served. <br /> d) Describe the population to be served or the area to benefit and indicate how you will <br /> identify beneficiaries. <br /> e) Who specifically will carry out the activities and in what location will they be carried out? <br /> Main Application 5/25/2016 9:07:15 AM 0 I:°' 3 6 of 33 <br />