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DocuSign Envelope ID:88AEE9BF-924A-442D-BD41-DC640F1 E1 BAC <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: MEDIATION <br /> Program Primary Contact and Title: Frances Henderson, Executive Director <br /> Telephone Number: 919 929-8800 ext 11 E-Mail: fhenderson@disputesettlement.org <br /> a) Indicate the type of Human Service Needs Priority, if program applicable: <br /> x 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 Youth Adult Elderly Disabled Public Housing <br /> Neighborhoods/Residents <br /> Affordable Housing <br /> Affordable Healthcare <br /> Education <br /> Family Resources <br /> Jobs/Jobs Training <br /> Food <br /> Transportation <br /> Other: Please specify x <br /> Community well-being <br /> through conflict <br /> resolution <br /> x 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) <br /> to be funded. For each, briefly describe the coordinated/collaborative efforts. <br /> We receive case referrals from these entities, among others: <br /> Orange County Criminal District Court; <br /> Orange County Civil District Court (50-C cases) <br /> Orange County Magistrates; <br /> Orange County Small Claims Court; <br /> Orange County Animal Control; <br /> Orange County Senior Centers; <br /> Orange County Clerk of Court; <br /> Orange County Department on Aging: <br /> PROGRAM INFORMATION 2/8/2017 11:26:12 AM Page 12 • .f 22 <br />