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DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: ECH-Carrboro Community Support Services <br /> Program Primary Contact and Title: Pilar Rocha Goldberg <br /> Telephone Number: (919) 687-4635 Ext. 43 E-Mail: prochaelcentronc.orq <br /> a) Indicate the type of Human Service Needs Priority, if program applicable: <br /> Z 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 /> Z Priority Area #3: programs aimed at improving health and nutrition of needy residents <br /> b) Indicate the type of program for which you are requesting funding <br /> (Check all that apply to this program) <br /> Public Housing <br /> Program Category Youth Adult Elderly I Disabled . <br /> Neighborhoods/Residents <br /> Affordable Housing <br /> Affordable Healthcare <br /> Education <br /> Family Resources x x x <br /> Jobs/Jobs Training <br /> Food <br /> Transportation <br /> Other: Please specify: <br /> information & referral, <br /> legal assistance, case <br /> management, <br /> communit outreach <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 Program(s) <br /> to be funded. For each, briefly describe the coordinated/collaborative efforts. <br /> • Compass Center: Partner to share some resources for support services and <br /> also refer directly to them. We assist them with some case management and <br /> legal assistance <br /> • Orange County Rape Crisis Center: We refer individuals to them and provide <br /> our space for one of OCRRC's staff to attend cases directly in Spanish on site. <br /> They provide workshops on sexual violence to our community. <br /> • El Futuro, Inc.: Accepts referrals for mental health and substance abuse <br /> treatment from us <br /> • Inter- Faith Council (IFC): Accept referrals for financial help or food from ECH. <br /> PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 9 of 32 <br />