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DocuSign Envelope ID:38357F45-0FD1-474F-992F-A2DODA42A3E2 t A- continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Facility in the Meadowlands in Hillsborough, which provides 24-hour care for those hospice <br /> patients in psychosocial crisis, unmanageable pain and/or need for respite care. In 1995, with <br /> a gift from GlaxoWellcome, the Beard House, which is on the same I I-acre site, was <br /> transformed into the Unicorn Bereavement Center. Staffed with two full-time bereavement <br /> counselors and one part-time bereavement counselor, the UBC serves both hospice families <br /> and those in the community who have lost a loved one. Each year, more than nine multi- <br /> week support groups and workshops are held at the UBC. We provide medical, psychosocial, <br /> spiritual and bereavement care for terminally ill patients and families, regardless of ability to <br /> pay. Bereavement services are provided to anyone in the community, regardless of <br /> connection to hospice, through individual, family, and group sessions, as well as in the <br /> Chapel Hill-Carrboro and Orange County School Systems. <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency& Program Name: Duke Home Care & Hospice <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 /> Ii 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 /> O HOME Other — (Main Application AND Part A AND Part B) <br /> Indicate the type of program for which you are requesting funding: <br /> i Public <br /> Program Category Youth Adult Elderly <br /> Disabled ruu'le Housing(not elderly) Neighborhoods/Residents <br /> Education X X X <br /> Health and Nutrition <br /> Job Training X X X <br /> Sports and Arts <br /> Activities <br /> Pre-School Activities <br /> After-School Activities <br /> Mentoring X X — X <br /> Transportation <br /> Housing <br /> Other: Please specify <br /> grief <br /> counseling X X X <br /> Main Application 1/25/2016 11:36:35 AM Page 5 of 16 <br />