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DocuSign Envelope ID:71415AD7-DCDD-4CF6-89A9-F93F72D8DC62 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: Meals on Wheels <br /> Program Primary Contact and Title: Kay Stagner, Manager of Client Services <br /> Telephone Number: 919-732-6194 ext.12 E-Mail: ocimsrm( embargmail.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 /> El Priority Area #2: education, mentorship, and afterschool programming for <br /> youth facing a variety of challenges <br /> X3Priority 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 Disabled <br /> Neighborhoods/Residents <br /> Affordable Housing <br /> Affordable Healthcare <br /> Education <br /> Family Resources <br /> Jobs/Jobs Training <br /> Food X X X <br /> Transportation <br /> Other: Please specify <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 /> • Orange County Department of Social Services: Meals on Wheels receives <br /> referrals about possible recipients from Adult Services social workers. <br /> • Orange County Department on Aging: Meals on Wheels receives referrals <br /> about possible recipients. Likewise, the Meals on Wheels Coordinator makes <br /> referrals to the Department on Aging when recipients seem to be in need of <br /> other services or there are health or safety concerns. <br /> • Various home health agencies: social workers, nurses and aides make <br /> referrals for their clients. <br /> • Are. congregations: Members of area congregations volunteer for Meals <br /> on Wheels as well as refer people who may need home-delivered meals. <br /> • Orange County IE ployees, PHE, Sports Endeavors, Bourough <br /> usiness Builders: Employees give up a lunch hour to deliver Meals on <br /> Wheels. <br /> PRrY4R11A/1 INFrWMATIMI 1/-41/7(117 1:?-16.0=4 IAñ P n a f 9 ")% <br />