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DocuSign Envelope ID:39EEFC69-D47C-4CE3-8A5C-0A87B55C2CD0 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: KidSCope Outreach <br /> Program Primary Contact and Title: Linda Foxworth, Director <br /> Telephone Number:919-644-6590 x 4810 E-Mail: Ioxworth@kidscope.chtop.org <br /> a) Indicate the type of Human Service Needs Priority, if program applicable: <br /> ® 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 /> ® Priority Area #3: programs aimed at improving health and nutrition of needy <br /> residents <br /> b) Indicate the type of program for which you are requesting funding <br /> (Check all that apply to this program) <br /> Program Category Youth Adult Elderly Disabled Public Housing <br /> Neighborhoods/Residents <br /> Affordable Housing <br /> Affordable <br /> Healthcare x <br /> Education x <br /> Family Resources x <br /> Jobs/Jobs Training <br /> Food <br /> Transportation <br /> Other: Please <br /> 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 <br /> Program(s) to be funded. <br /> KidSCope coordinates services with the similar programs and agencies in order to <br /> ensure that children in need are identified and referred in a timely, efficient manner. <br /> These agencies include: <br /> • Children's Developmental Services Agency (CDSA) <br /> • Orange County Department of Social Services <br /> • Child Care Services Association <br /> • Orange County Health Department <br /> PROGRAM INFORMATION 2/9/2017 11:59:17 AM I: W,1 gc 10 u0 f I / <br />