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DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 Exhibit A <br /> Provider's Outside Agency Application <br /> A. <br /> APPLICATION SU MITTAL CHECKLIST FOR OFFICE USE ONLY <br /> Received By <br /> Agency Orange County Partnership for Young Children Date/Time <br /> Program(s) Transplanting Traditions Community Farm <br /> Section For CDBG & HOME - <br /> Subsection <br /> HUD Regulations <br /> 1. Cover Page a. Applicant Contact Information <br /> b. 1 Project/Program Contact Information <br /> C. 4 Funding Requests Identified <br /> d. i4 Signed Application Cover Page <br /> 2. Agency a. Z Agency's Years In operation 24 CFR 570,506, <br /> Information - b. L Agency's Purpose/Mission 570.507, 570.610 24 <br /> CFR Parts 84 or 85 <br /> c. 4 Agency's Types of Services Provided <br /> d. 4 Agency's Experience <br /> e. Z Other Pertinent Information <br /> 3. Program/ a. Type of Application and Program Identified 24 CFR 570.200(a), <br /> Project b. Summary of Program 570.201-570 208, <br /> Information - c. Description of Identified Need <br /> (for each d. I1 Description of Population to be Served <br /> program/ <br /> e. M Activity Manager and Location Description <br /> project for <br /> which funding f. Z Activity Implementation Timeline <br /> is requested) g' Agency Collaboration <br /> h. Z Describe Impact of Reduced/No Allocation <br /> i. Other Pertinent Information <br /> j. D:j Complete Target Population/Beneficiary Chart <br /> k. Z Complete Schedule of Positions <br /> I. Z Signed Conflict of interest Disclosure <br /> m. 4 Complete Work Statement <br /> i I I 3 <br />