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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 /> allocation is recommended. <br /> If Funding is not awarded, we would have to find additional sources for support because <br /> one thing that will not happen if we are not funded by this grant is that we would let this <br /> program close- because the youth are too important for that to happen. It is hard to <br /> understand, though, why the funds sought would not be provided for this program that is <br /> so central to goals and priorities and so important to the quality of life in the Chapel Hill- <br /> Carrboro area. And these funds are for children who, truly, need us most, who have not <br /> heretofore had access to afternoon programs in Chapel Hill-Carrboro. <br /> The program is currently supported by ongoing individual donors, corporate donations, and <br /> grants. We expect to be chartered by BGCA during 2016 which will open up additional <br /> opportunities for funding assistance through Boys & Girls Clubs of America and state and <br /> national funding. All of this will assist us in being able to support the program. <br /> Did you know that over 70% of adults who have attended BGCs in their youth said it <br /> SAVED THEIR LIVES? We are in the business of saving lives. Why would organizations <br /> not want to fund us fully? <br /> Program/Project Information <br /> d) Complete the Target Population and Program Beneficiary Demographics Chart <br /> e) Complete the Schedule of Positions Chart for Program Staff <br /> f) Disclosure of Potential Conflicts of Interested must be signed <br /> g) 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 goals <br /> and objectives. Describe who will be responsible for monitoring progress. <br /> Information to Complete <br /> j.) Target Population <br /> Complete the following tables to the best of your ability. Show numbers of participants and <br /> percentages, as applicable, in each category. <br /> Please indicate whether this project/program will serve: ❑ Persons ❑ Households ❑ Units <br /> Program: BGCEP Program for Impact <br /> Program Beneficiary <br /> Demographics <br /> Actual Estimated Projected <br /> 2014-15 2015-16 2016-17 <br /> Gender Not open <br /> Male Not open 22 40 <br /> Female Not open 10 26 <br /> Total 32 66 <br /> Not open <br /> Main Application 5/24/2016 8:59:25 a5/p5 P 10 o of 23 <br />