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DocuSign Envelope ID: 571863E8-F892-43F0-B73F-4AB062ACBOBF XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 919-918-7319 <br /> astone(@,townofcarrboro.orq <br /> Submission: <br /> ➢ We strongly encourage applications to be single-spaced, with 12-point anal <br /> font and normal margins. <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.orcr <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 /> DO NOT SUBMIT THIS PAGE 1/26/2017 11:10:15 AMIII'age 4 ,t 31 <br />