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DocuSign Envelope ID: E85EF868-A4BB-49ED-96E1-165F3DADBAE4 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: Client Services <br /> Prograrn Primary Contact and Title; Bethany Vilichman-Buescher, Chant Services Director <br /> Telephone Number: 919-968-4647 E-Mail: bethanvocrcc.org <br /> a) Indicate the type of Human Service Needs Priority, if program applicable: <br /> ri. Priority Area #1: safety-net services for disadvantaged residents <br /> — Priority Area #2: education, mentorship, and afterschool programming for <br /> youth facing a variety V 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 Disabled <br /> Neighborhoods/Residents <br /> Affordable Housin• <br /> Affordable Healthcare X X X 1 <br /> X X <br /> Education <br /> Family Resources X X X X X <br /> Jobs/Jobs Trainii29 <br /> Food' <br /> Transportation <br /> Other: Services for <br /> victims of crime <br /> X X X X X <br /> lrvivors of sexual <br /> assault <br /> c) Provide a bulletedl 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 /> • OC Domestic Violence Needs Assessment Planning Committee: Along with community <br /> members, service providers, and researchers, the OCRCC sits on this committee to address the <br /> need for a local shelter for violence survivors. <br /> • Chapel lill-Carrboro City Schools: OCRCC serves as a consultant for technical assistance and <br /> professional training for local school social workers and counselors on preventing and responding <br /> to sexual violence in schools. We collaborate with staff to promote school safety and ensure student <br /> survivors receive appropriate intervention and care. <br /> • NC Coalition Against Sexual Assault: In FY12-13 and FY13-14, the OCRCC collaborated with <br /> NCCASA to create a training program and manual for establishing a comprehensive support group <br /> (SG) program. We also partner on other projects, such as professional development and staff <br /> training. <br /> Agency Information 1/30/2017 5:14:05 PM n 7 f 2 2 <br />