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DocuSign Envelope ID:E522BFFC-A634-4A11-A162-195A3BE957A4 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: Duke HomeCare & Hospice <br /> Program Primary Contact and Title: William Holloman <br /> Telephone Number: 919.644.6869 E-Mail: William.holloman@duke.edu <br /> a) Indicate the type of Human Service Needs Priority, if program applicable: <br /> Human Services <br /> Li Priority Area#1: safety-net services for disadvantaged residents <br /> E Priority Area #2: education, mentorship, and afterschool programming for <br /> youth facing a variety of challenges <br /> E 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 Housing <br /> Affordable Healthcare <br /> Education x x X <br /> Family Resources <br /> Jobs/Jobs Trainins <br /> Food <br /> Transportation <br /> Mentoring <br /> Other: Please specify <br /> counseling <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 /> See attached. <br /> Program Description (3 pages OR LESS) <br /> Please provide the following information about the proposed program: <br /> d) Summarize the program services proposed and how the program will address a <br /> Town/County priority/goal? <br /> See attached. <br /> PROGRAM INFORMATION 1/30/2017 11:11:11 AM Page 11 of 18 <br />