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DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: Behavioral Insights: Programming to Fulfill Court and CPS Mandates <br /> (All class offerings are grouped together because we cannot predict to which program <br /> participants will be referred). <br /> Program Primary Contact and Title: Kathryn Bauman, Executive Director <br /> Telephone Number: (919) 391-0365 E-Mail: kathrvnibaumanna gmail.com <br /> a) 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 /> X Priority Area #3: programs aimed at improving health and nutrition of needy <br /> 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 <br /> Healthcare <br /> Education X X X X <br /> Family Resources X X X X <br /> Jobs/Jobs Training <br /> Food <br /> Transportation <br /> Other: Please <br /> specify: <br /> Court and CPS- <br /> mandated <br /> programming 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 <br /> Program(s) to be funded. For each, briefly describe the coordinated/collaborative <br /> efforts. <br /> • Department of Social Services — Our staff provides presentations and <br /> liaises with DSS staff to enroll participants and support their case <br /> management needs <br /> ® Community Corrections (Probation) —We liaise with staff to receive <br /> referrals and provide/receive updates regarding participant progress <br /> PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 1 1 of 21 <br />