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DocuSign Envelope ID:E522BFFC-A634-4A11-A162-195A3BE957A4 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> in Orange County as well as administrative offices of those districts and other gathering places <br /> which will accommodate the provision of services requested. <br /> (h) Describe period: <br /> Camp ReLEAF is an annual event and is next scheduled for April 28 — 30, 2017. It will be held <br /> at Camp New Hope. This schedule is followed as closely as possible each year after adjusting <br /> for holidays or religious events which may interfere with those periods of time. <br /> During the school year school based grief support groups are located at the requesting school site <br /> and will run for a total of 6 weeks. The frequency will be determined by the number of requests <br /> received. <br /> Individual, group and family grief support is provided as needed and according to mutual <br /> developed goals established between the requesting person and the Duke Hospice Bereavement <br /> staff. <br /> Crisis intervention is available as requested. <br /> School consultation is available upon request throughout the year. <br /> (i) Why is funding a good investment? <br /> • Death touches the lives of young people far more frequently than most of us would like to <br /> admit. <br /> • US Census Bureau stars— 5% by 16; 11% by 20 <br /> • 90% of HS Students say they have experienced the death of a significant person in <br /> their life <br /> • 40% will experience the death of a peer. 20% will have witnessed a death. <br /> • Impact is widespread and not contained to a specific period of time. Grief is a multi- <br /> dimensional experience Developmental in nature— change in understanding and <br /> experience. <br /> • Impacts learning, behavior, and development. Our work supports school personnel are in <br /> a unique position to interact with children who are challenged to meet educational <br /> objectives while trying to negotiate the very difficult emotional terrain in adjusting to the <br /> death of a family member or friend. <br /> • Many feel unprepared to respond to the needs of grieving students. The 2012 Study by <br /> AFT and NY Life revealed: <br />