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DocuSign Envelope ID:88AEE9BF-924A-442D-BD41-DC640F1 E1 BAC <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Homeowners' Associations (HOAs): <br /> Chapel Hill Police Department Crisis Unit; <br /> Orange County DSS; <br /> Town of Chapel Hill Ombuds Office; <br /> Town of Chapel Hill Human Resources; <br /> Town of Carrboro; <br /> Chapel Hill- Carrboro City Schools; <br /> Orange County Schools; <br /> Family law attorneys; <br /> Family therapists; <br /> NC Office of Administrative Hearings (Medicaid Appeals) <br /> Compass Center; <br /> Congregations, nonprofits and businesses; <br /> Senior Care providers. <br /> Program Description (3 pages OR LESS) <br /> Please provide the following information about the proposed program: <br /> d) Summarize the program services proposed and how the program will address a <br /> Town/County priority/goal? <br /> In Orange County Criminal District Court, the judges and assistant district attorneys <br /> refer cases to us and we then screen for appropriateness and voluntariness. An <br /> appropriate case involves an interpersonal dispute (leading to, for example, charges <br /> of harassment, communicating a threat, injury to personal property, etc.) without <br /> domestic violence, in which the parties agree to mediate. <br /> Most court clients have very few resources and often need to get back to their jobs. <br /> They also need real resolution of the problem between themselves and their <br /> neighbor, co-worker, or family member. <br /> In the case of family mediation, clients are referred to Dispute Settlement Center <br /> through attorneys, therapists, or social services agencies, or self-referred. Our <br /> sliding scale fee structure enables people of all income levels to have access to <br /> high quality mediation. <br /> Medicaid Appeals cases are referred to us through a program through Office of <br /> Administrative Hearings. This program serves the very poor and disabled in Orange <br /> County who have been denied Medicaid services or support and have appealed the <br /> denial. <br /> The Orange County Board of County Commissioners' goals include to "Create a <br /> Safe Community" and to "Foster a community culture that rejects oppression and <br /> inequity." Dispute Settlement Center helps people in conflict work through their <br /> differences in safe environments so that they can move on with their lives with less <br /> stress and perhaps improved relationships. Through the mediation process, they <br /> may learn skills that help them speak up for themselves more effectively. This, we <br /> PROGRAM INFORMATION 2/8/2017 11:26:12 AM II I:' I 3 r 2 2 <br />