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DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A <br />PROVIDER'S OUTSIDE AGENCY APPLICATION <br />3. PROGRAM INFORMATION {Submit a separate Section .3 for each program} <br />Program Name: Florence Gray Soft Vs Adult DaV Health Program <br />Program Primary Contact and Title: Alvonia Baldwin Director <br />Telephone Number: <br />919- 245 -2017 <br />E -Mail: albaldwin(cDorangecountync.gov <br />a) Indicate the type of Human Service Needs Priority, if program applicable: <br />X 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 />X 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 />Program Cafiegory` <br />Youth <br />Adult <br />Elderly <br />Disabled <br />Publ4c Ho�s�ng <br />, <br />NeighbbrhaadslRestdents <br />Affordable Housing <br />Affordable Healthcare <br />Education <br />Family Resources <br />X <br />X <br />Jobs /Jobs Training <br />Food <br />Transportation <br />Other: Please specify <br />Adult Day Health <br />Program <br />X <br />X <br />X <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 on Aging- Referrals to our program from OC <br />Cares, Caregiver Respite Support, $25,000 in -kind donation for meals. <br />• Orange County Department of Social Services- Referrals from the adult <br />division of DSS <br />• Triangle J Council of Governments- ( HCCBG) Home Community Care Block <br />Grant Funding annually for adult day health and social participants. <br />• The Veterans Administration Services; maintains a federal contract for Adult <br />Day Health qualified Veterans. <br />Program Description (3 pages OR LESS) <br />Please provide the following information about the proposed program: <br />Page 14 of 26 <br />