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DocuSign Envelope ID:ODO4B5DD-363F-41 FF-BD24-FAD291133B51 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> ➢ Application: One (1) original plus Two (2) paper copies of the application <br /> must be hand delivered or mailed to Annette Stone, 301 West Main <br /> Street, Carrboro, NC 27510; AND <br /> ➢ One Application and Attachments files must be submitted by email. Any .pdf <br /> files must be accompanied by the original file format of .doc, .xls, etc. <br /> Human ervice Town a el Hill <br /> In 1982, the Town established local funding to support local nonprofit organizations that <br /> carry out human service work throughout the community. <br /> Applications are accepted once a year and reviewed by the Town's Human Services <br /> Advisory Board, which makes a recommendation for funding to the Town Council for final <br /> approval. <br /> For more information about the Town of Chapel Hill Human Services program, see here. <br /> Questions and submittals should be directed to: <br /> Jackie Thompson <br /> 405 Martin Luther King Jr. Blvd. <br /> Chapel Hill, NC 27514 <br /> 919-969-5081 <br /> jhompson(@,townofchapelhill.orq <br /> Submission: <br /> ➢ We strongly encourage applications to be single-spaced, with 12-point anal <br /> font and normal margins. <br /> ➢ Application: Two (2) paper copies of the application with ORIGINAL <br /> signatures must be hand delivered or mailed to Jackie Thompson, 405 <br /> Martin Luther King, Jr. Blvd., Chapel Hill, NC 27514; AND <br /> ➢ Attachments: The application submittal must be accompanied by a flash drive <br /> with the application and all attachment files in electronic format. Any .pdf <br /> files must be accompanied by the original file format of .doc, .xls, etc. <br /> Human ervice Orange County <br /> For more information about the Orange County Human Services program, see here. <br /> Questions and submittals should be directed to: <br /> Allen Coleman <br /> PO Box 8181 <br /> Hillsborough, NC 27278 <br /> (919) 245-2151 <br /> DO NOT SUBMIT THIS PAGE 12/15/2016 9:57:17 AMII'age 4 ,t 32 <br />