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DocuSign Envelope ID:78F84828-4CC5-4A5B-B256-33C571A84687 t A- continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency & Program Name: Charles House: Daytime Eldercare Program <br /> As you complete your application, complete only those sections that pertain to the type of application <br /> you are submitting. The application is divided into several sections and not all sections apply to every <br /> 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 /> 11 Human Services (Main Application Only) <br /> 111 CDBG Non-Construction —(Main Application AND Part A) <br /> El CDBG Construction —(Main Application AND Part A AND Part B) <br /> 111 HOME CHDO Set-aside —(Main Application AND Part A) <br /> El HOME Other — (Main Application AND Part 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 <br /> Health and Nutrition <br /> Job Training <br /> Sports and Arts <br /> Activities <br /> Pre-School Activities <br /> After-School <br /> Activities <br /> Mentoring <br /> Transportation <br /> Housing <br /> Other: Please <br /> specify <br /> Daytime Eldercare <br /> Proaram/Project Description (Label your responses as outlined below; not to exceed 3 pages.) <br /> Please provide the following information about the proposed program/project: <br /> a) Summarize the program services proposed and how the program will address the chosen <br /> Town/County priority? <br /> The Chapel Hill Human Services Advisory Board has identified this priority: <br /> To fund programs aimed at improving health and nutrition of needy residents. <br /> Charles House Daytime Eldercare Program provides significant support to the health, nutrition and <br /> wellbeing of some of the most frail citizens in our community and supports the health of their family <br /> caregivers. <br /> Main Application 1/25/2016 11:54:37 AM Page 6 of 21 <br />