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DocuSign Envelope ID: EB541A3B-1E01-49AB-9E09-7987ECAEC1C4 I A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> • Marian Cheek Jackson Center for Saving and Making History- helped gather al <br /> preserve the stories of neighborhood residents and related data to help us build a> <br /> present our case before the local governments <br /> • Orange County, Carrboro, and Chapel Hill Governments- The Rogers Road sm. <br /> area task force has offered a unified table with neighborhood leaders to wo <br /> together toward solutions to the unique challenges the Rogers-Eubanks communi <br /> faces. The municipal governments recognize the need for, and are helpii <br /> strengthen, the new community center that we hope will be a site of neighborhoo <br /> rooted revitalization <br /> • Human Resource Center- The children who participate in RENA programs unite wi <br /> HRC's children to play soccer, play softball, and enjoy movie nights <br /> • Habitat for Humanity-H4H residents participate in Community Unity Board, o <br /> primary coalitional vehicle, and attend neighborhood celebrations, Back to Scho <br /> Bash, and other functions. <br /> • Faith Tabernacle Oasis of Love International Church- Hosts community meeting <br /> and other functions as needed. Allowed us to conduct afterschool tutoring, Summ <br /> Enrichment Camp, and the Back to School Bash here while we waited for the n( <br /> community center to be built. Congregation members make small donations <br /> support our work. <br /> • Universalist Church on Purefoy- Have offered small donation to support our woi <br /> and they are dependable allies when we seek community support for our justi <br /> work. <br /> h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation <br /> recommended. <br /> • If no funding is provided we will only be able to provide 100 backpacks with suppliE <br /> instead of 500 <br /> • If there is no funding for the Community Garden there will be no free fruits an <br /> vegetables to help with the afternoon snack for the after school program as well as n <br /> fruits or v0egetable to help with the food bags that are passed out from our food bank <br /> • If there is no funding for the Summer Enrichment Camp the day to day functions w <br /> not be able to be carried out. There will be no science labs, bike rodeos, lunch ( <br /> snacks provided for the kids. <br /> i) Include any other pertinent information. <br /> Program/Project Information <br /> j) Complete the Target Population and Program Beneficiary Demographics Chart <br /> k) Complete the Schedule of Positions Chart for Program Staff <br /> • Program Director <br /> • Executive Director <br /> • Operator <br /> • Teachers (2 part-time) <br /> • Counselors (4 Chapel Hill Youth Program, 4 RENA Youth Program) <br /> • Volunteers/Instructors <br /> I) Disclosure of Potential Conflicts of Interested must be signed <br /> m) Complete the Work Statement Chart to describe the work to be performed, and be sure to attach copies <br /> all data collection tools that will be used to verify achievement of program goals and objectives. Descrii <br /> who will be responsible for monitoring progress. <br /> Main Application 1/25/2016P a g 9 of 3 <br />