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DocuSign Envelope ID:8E4BA2A0-F8F0-406A-A380-E6C66CCD78B4 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: Charles House: Daytime Eldercare Program <br /> Program Primary Contact and Title: Paul Klever, Executive Director <br /> Telephone Number: 919-967-7570 E-Mail: paulRcharleshouse.org <br /> a) Indicate the type of Human Service Needs Priority, if program applicable: <br /> Di Priority Area #1: safety-net services for disadvantaged residents <br /> LI Priority Area #2: education, mentorship, and afterschool programming for <br /> youth facing a variety of challenges <br /> Zi 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 /> Public Housing <br /> Program Category Youth Adult Elderly Disabled Neighborhoods/Residents <br /> Affordable Housing <br /> Affordable Healthcare X X <br /> Education <br /> Family Resources <br /> Jobs/Jobs Training <br /> Food <br /> Transportation <br /> Other: Please specify <br /> Daytime Eldercare X X <br /> • 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) <br /> to be funded. For each, briefly describe the coordinated/collaborative efforts. <br /> • Orange County: Department on Aging—collaboration on various projects, including the <br /> Master Aging Plan, the Aging-in-Community series, sharing referrals for aging transitions, <br /> long-term care collaborative, contractually serve Orange County families/caregivers. <br /> • Orange County: Department of Social Services—collaboration on contractually serving <br /> Orange County families/caregivers, as well as with Adult Protective Services and regulatory <br /> oversite done by DSS. <br /> • UNC-Chapel Hill—collaborations with many of the schools and academic <br /> departments/programs on opportunities for learning & service for students/interns. <br /> • UNC Health Care—collaboration on clinical initiatives, volunteers and Charles House <br /> leadership <br /> • Duke University—collaboration with the Fuqua Business School, Medical School and Family <br /> Support Program. <br /> • Central Carolina University—collaboration with the school of social work. <br /> • Durham Technical—collaboration with the occupational therapy assistant program <br /> • Watts School of Nursing—collaboration on service learning <br /> PROGRAM INFORMATION 1/27/2017 4:52:00 PM Page 7 of 16 <br />