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DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency& Program Name: EmPOWERment, Inc. <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 /> xxxi I Human Services (Main Application Only) <br /> CDBG Non-Construction — (Main Application AND Part A) <br /> Lii CDBG Construction — (Main Application AND Part A AND Part B) <br /> Li HOME CHDO Set-aside — (Main Application AND Part A) <br /> 0 HOME Other — (Main Application AND Part A AND Part B) <br /> Indicate the type of program for which you are requesting funding: <br /> Disabled Public Housing <br /> Program Category Youth Adult Elderly <br /> (not elderly) Neighborhoods/Residents <br /> Education (Housing <br /> Counseling) X X X X <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 X X X X <br /> Other: Please <br /> specify <br /> Program/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 /> b) Summarize the program services proposed and how the program will address the chosen <br /> Town/County priority? <br /> Process for filling vacancies includes the following services <br /> Unit Turnover Cleaning and repairs <br /> Receiving Applications Through online submission and in office <br /> visits <br /> Main Application 1/21/2016 2:38:15 PM P a g e 7 a f 24 <br />