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DocuSign Envelope ID:AB039DC1-8309-4D41-B525-6E84F973FAA6 <br /> EXHIBIT A - PROVIDER'S OUTSIDE AGENCY APPLICATION CONTINUED <br /> MAIN APPLICATION <br /> 3. PROJECT/PROGRAM INFORMATION <br /> Agency& Program Name: The Exchange Club's Family Center in Alamance/ Parent Aide 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 /> CDBG Non-Construction —(Main Application AND Part A) <br /> EJ CDBG Construction —(Main Application AND Part A AND Part B) <br /> HOME CHDO Set-aside —(Ma In Application AND Part A) <br /> El 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 <br /> Job Training_ <br /> Sports and Arts <br /> Activities <br /> Pre-School Activities <br /> After-School <br /> Activities <br /> Mentoring X X X X <br /> Transportation X X X X <br /> Housing <br /> Other: Please X <br /> specify(Parenting <br /> Support) <br /> X X <br /> Main Application 1/24/2016 4:55:46 PM Page 6 of 2 1 <br />