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DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: IMyBr, ther`s Keeser MBK Oran*ecounty <br /> Program Primary Contact and Title: Atrayus Goode, President & CEO, Movement of Youth <br /> Telephone Number: X600) 956-3820 E-Mail: a'oode • movemgntof outh.or. <br /> • Indicate the type of Human Service Needs Priority, if program applicable: <br /> ❑ 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 /> • 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 Housin• <br /> Affordable Healthcare <br /> Education <br /> ... .. ........ ... �.. <br /> n x <br /> Famil Resources x <br /> Jobs/Jobs Traininc x <br /> Food _ _......... ... _.._. .._.. ..................... <br /> Trans•ortation <br /> Other: Please specify <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 /> • Beyond Expectations is dedicated to mentoring adolescents in grades 6 through <br /> 12 in Orange County, NC. On two Saturdays each month, youth participate in a <br /> variety of activities to support them academically, emotionally, and socially. Jeff and <br /> Charlene Campbell, Program Directors, have actively supported MBK Orange <br /> County activities for the past two years, through coordination of community summits. <br /> They will continue serving MBK Orange County through work on the inaugural <br /> Board of Advisors. <br /> • Fathers on the Move provides transitional services to males over the age of 16 who <br /> are involved in the criminal justice system and have children. The program is also <br /> open to all males needing support, guidance and mentorship. Victor Glover, leader <br /> of Fathers on the Move, has supported MBK Orange County as a member of the <br /> Board of Advisors. <br /> PROGRAM INFORMATION 1/31/2017 3:24:15 PM I ig c 1 5 o f 2 9 <br />