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DocuSign Envelope ID:B32F3E9F-996A-4000-8CAF-83514F2E5759 t A- continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency & Program Name: Weekend Meal Backpack 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 /> Human Services (Main Application Only) <br /> LI CDBG Non-Construction — (Main Application AND Part A) <br /> CDBG Construction — (Main Application AND Part A AND Part B) <br /> FT HOME CHDO Set-aside — (Main Application AND Part A) <br /> 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 <br /> Health and Nutrition X <br /> Job Training_ <br /> Sports and Arts <br /> Activities <br /> Pre-School Activities <br /> After-School <br /> Activities <br /> Mentorin. <br /> Transportation <br /> Housin. <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 /> c) Describe the local need or problem to be addressed in relation to the Consolidated Plan or <br /> other community priorities (i.e. Council/Board Goals). Cite local data to support the need for <br /> this program and the population being served. <br /> d) Describe the population to be served or the area to benefit and indicate how you will identify <br /> beneficiaries. <br /> e) Who specifically will carry out the activities and in what location will they be carried out? <br /> Main Application 1/25/2016 11:34:49 AM Poge 5 c) 2 1 <br />