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DocuSign Envelope ID:87560079-2786-4376-A189-DC48D9482BE7 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM CNFORMIIIATION (Submit a separate Section 3 for each program) <br /> Program Name: Parent Aide Program <br /> Program Primary Contact and Title: Sarah Black, Director <br /> Telephone Number: 336-227-5601 E-Mail: sarah.black(cr�exchangescan.org <br /> a) Indicate the type of Human Service Needs Priority, if program applicable: <br /> ❑ Priority Area#1; safety-net services for disadvantaged residents <br /> Priority Area#2: education, mentorship, and afterschool programming for <br /> youth facing a variety of challenges <br /> ® Priority Area#3: programs aimed at improving health and nutrition of needy residents <br /> b) Indicate the type of program for which you are requesting funding � <br /> (Check all that apply to this program) <br /> Program Category Ybe h , Adrift 1=lderly Res bled oncc Housing <br /> Neighbborhoods/Residents <br /> Affordable Housing <br /> Affordable Healthcare _ <br /> Education I� <br /> Family Resources X X X X X <br /> Jobs/Jobs Training X X X <br /> Food <br /> • <br /> Transportation X X X X <br /> Other: Please specify X <br /> (parenting support) <br /> x x x <br /> c) Provide a bulleted list of other agencies, if any, with which your agency <br /> coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s)to <br /> be funded. For each, briefly describe the coordinated/collaborative efforts. <br /> • Department of Social Services and Department of Health: referrals, governmental <br /> services. Agency has a Memorandum of Agreement with Orange County's Department of <br /> Social Services. <br /> • Department of Juvenile Justice and Orange County Court System: referrals. <br /> • Orange County I Chapel Hill School System/ UNC-Chapel Hill: referrals and interns. <br /> • Mental Health/Social Service Agencies/ Local Mental Health Entities: referrals and mental <br /> health services. <br /> • Exchange Clubs/Churches/Business: These entities assist the agency by providing <br /> monetary donations, concrete donations for items needed by families, and volunteers for <br /> serving families in Orange County. <br /> PROGRAM INFORMATION 1/27/2017 1:48:20 PM Page 6 of 12 <br /> • <br />