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DocuSign Envelope ID: B701CF6A-1C9A-46CB-9234-56F771D80955 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 2. AGENCY INFORMATION <br /> Boomerang is filing to become an independent non-profit organization, separating from YMCA of the <br /> Triangle Area, Inc.The YMCA's fiscal responsibility for Boomerang will end once the latter receives its <br /> 501(c)3 tax-exempt status (estimated August-September 2016). At that time, Boomerang will provide its <br /> own documentation—IRS Federal Tax-Exemption Letter, Certificate of Liability Insurance, and NC Solicitation <br /> License—to be in compliance with Outside Agency funding requirements. The YMCA of the Triangle Area, <br /> Inc., is deferring authorization and approval of this application to Boomerang's Board of Directors. <br /> Boomerang Board of Directors <br /> Board President: Isabel Geffner, Interim Education Director,Judea Reform <br /> Secretary: Dana Brinson, Oak Foundation <br /> Treasurer: Kellie Mannette, Mannette Law <br /> Directors: Gretchen Aylsworth, Community Member <br /> Jennifer Boger, Community Member <br /> Alonzo Jaynes, Assistant Police Chief,Town of Chapel Hill <br /> Sonny Kelly, Doctoral Student, UNC-Chapel Hill <br /> Quincy McDuffie, Student, Durham Tech <br /> Maggie Mraz, Parent/Community Member <br /> Kendra Suggs, Behavior Specialist, Chapel Hill-Carrboro City Schools <br /> Please provide the following information about your agency (Limit of 2 pages total): <br /> a) Years in Operation, Date of Incorporation (Month/Year) <br /> b) Agency's Purpose/Mission <br /> c) Types of Services the Agency Provides <br /> d) Agency's Experience with Similar Programs as the Funding Request <br /> e) Other Pertinent Agency Information <br /> In 2005,the Chapel Hill-Carrboro Y brought together a broad-based, multi-agency'group to address the <br /> growing number of short-term suspended students who were out of school. In 2006, the Chapel Hill- <br /> Carrboro Y launched Boomerang as a resiliency-based alternative to short-term suspension that provided <br /> youth at risk for disconnection with their community a supportive alternative environment for out of school <br /> time. <br /> Boomerang's programs support Orange County youth in cultivating skills for personal success, academic <br /> growth, and community engagement in a supportive environment during out of school time. <br /> Positive Alternative to Suspension <br /> Boomerang's alternative to suspension program provides a structured and supervised environment for 6th <br /> to 12th grade students who have been short-term suspended from school. Students who are on 3, 5 or 10- <br /> day suspensions are referred by local public school systems. Parents/guardians may also refer their child. <br /> Students: <br /> • Engage in 1:1 sessions with licensed staff to discuss underlying issues that led to the suspension, identify <br /> their strengths and alternative behaviors. <br /> • Receive academic support and tutoring to stay on task with schoolwork. <br /> • Build social skills and identify core values during structured group discussions. <br /> 1 <br /> Chapel Hill-Carrboro YMCA,Chapel Hill-Carrboro City Schools,Community Backyard, Department of Juvenile Justice, <br /> Dispute Settlement Center, UNC and Volunteers for Youth. <br /> Main Application 5/24/2016 9:22:20 AM of 2 I <br />