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DocuSign Envelope ID:2164F437-BF9D-46A1-B13B-7740B02003DA t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> children are eligible to join, the Club focuses on the population who needs us most, those unable to <br /> access other Chapel Hill after-school programs, even on scholarship, which often have waiting lists. <br /> The program opened in January 2015 at the Northside School in Chapel Hill with 17 children <br /> enrolled. With this new school year, we have expanded to serve 32 elementary age children <br /> four days a week in the Community Impact Program at the Northside Elementary School in <br /> Chapel Hill with an average of 27 children in daily attendance. <br /> d. Agency's Experience with Similar Programs as the Funding Request: The BGCEP has <br /> opened a Boys & Girls Club in Siler City in Chatham County six years ago and it has grown <br /> to over 100 youth registered with a waiting list of 60 youth and from the high school <br /> graduating class this year, three of its members now are attending UNC and all went on to <br /> promising future plans, either more education or work and one into the armed services! <br /> e. Other Pertinent Agency Information: <br /> All Boys & Girls Clubs are unique in that it they are affordable and accessible. The charge for <br /> membership in the Chapel Hill Program for Impact is $20/year per child. Scholarship support is <br /> also available so that no child will be turned away because of lack of finances. The program is <br /> open four days a week during the school year, available to youth from kindergarten through <br /> 12th grade. This year we are exploring the possibility of a 6 week program for the summer of <br /> 2016 so that gains made during the year will not be lost over the summer.. <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency & Program Name :BGCEP; Community Impact Program (Program for Impact) in Chapel <br /> Hill, NC <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 /> ▪ Human Services (Main Application Only) <br /> n 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 /> Program Category Youth Adult Elderly Disabled Public Housing <br /> (not elderly) Neighborhoods/Residents <br /> Education X 0 0 0 0 <br /> Health and Nutrition X 0 0 0 0 <br /> Job Training <br /> Sports and Arts <br /> Activities <br /> Pre-School Activities <br /> Main Application 5/24/2016 8:59:25 a5/p5 0 t 5 f 23 <br />