2017-485-E Finance - Bridge II Sports - Outside Agency Performance Agreement

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DocuSign Envelope ID:88377437-EE99-4E08-B6B1-CD4F113C0672 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • Are trained and certified in the SafeSport program created by the USA Olympic/Paralympic Committee • Are trained and certified in concussion training by the Centers for Disease Control (CDC) • Are trained and certified in Positive Coaches Alliance • Are trained and certified in Red Cross First Aid and CPR Additional Program Information I) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, The athlete numbers provided below include only those athletes who are considered paid members of Bridge II Sports. The numbers below exclude the following: athletes considered nonmembers, athletes competing with BITS from external teams, athletes and participants competing in BITS tournaments, athletes and participants who actively engage and obtain benefit from BITS community events and outreach activities, disabled Veteran athletes who competed in the 2016 Valor Games Southeast boccia tournament held in Chapel Hill, UNC experiential learning experiences in boccia programming, and #EverybodyPlaysNC school initiative boccia programming. The total number of all BITS boccia athletes who are paid members, plus the number of people mentioned in the categories above who are not included in the Program Target Population Demographics below, equates to 239 people in 2016. Program Target Population Demographics Actual Estimated Projected 2015-16 2016-17 2017-18 Gender Male 7 8 9 Female 6 7 8 Total 13 15 17 Ethnicity African-American 2 3 4 American Indian or Alaska Native Asian 2 3 3 Caucasian 9 9 10 Native Hawaiian or other Pacific Islander Other: specify Total 13 15 17 Of the above, how many Hispanic/Latino 0 0 0 Of the above, how many non-Hispanic/Latino 13 15 17 Total 13 15 17 Age PROGRAM INFORMATION 1/27/2017 3:48:29 PM Pago 13 of 2 6