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DocuSign Envelope ID: 134C4810- 3CA5- 4008- 9E74- 2A07D3AECED8 <br />EXHIBIT A - PROVIDER'S OUTSIDE AGENCY APPLICATION <br />2. AGENCY INFORMATION (Be Very Brief and Concise) <br />Please provide the following information about your agency (2 pages OR LESS): <br />a) Years in Operation, Date of Incorporation (Month/Year): August /2004 <br />Club Nova was founded July 1, 1987. Our founding members were at the core of our <br />inception. Club Nova has been in operation for almost 30 years, operating for 19 years <br />under the auspices of OPC Area Authority. Club Nova Community, Inc. incorporated on <br />August 23, 2004. On May 21, 2006, Club Nova was divested and came under the <br />governance of Club Nova Community, Inc. We have operated as a private non - profit for <br />over 10 years. <br />b) Agency's Purpose /Mission (no more than a few sentences): <br />Club Nova provides opportunities for individuals living with sever and persistent mental <br />illness to lead meaningful and productive lives of their choice in the community. Club <br />Nova focusses on members' strengths and potential rather than their illness. <br />c) Types of Services the Agency Provides (bullet format): * * ** <br />The Basic Components of Clubhouse: Community Support <br />• Members get help with acquiring and keeping affordable and dignified homes. <br />• Members get help with government disability and pension benefits. <br />The Basic Components of Clubhouse: Supported Housing <br />• Club Nova is committed to securing a range of choices of safe, decent and <br />affordable housing including independent living opportunities for all members. <br />• Members choose the location of their housing and their roommates. <br />• The level of support increases or decreases in response to the changing needs <br />of the members. <br />The Basic Components of Clubhouse: Health and Wellness <br />• Club Nova provides 13 affordable, nutritious meals each week. <br />• Members are given help accessing and navigating the social and healthcare <br />services they require. <br />• Members get help with averting crisis and crisis intervention. <br />• Members have opportunities to participate in smoking cessation other wellness <br />programming. <br />The Basic Components of Clubhouse: Outreach <br />• When a member does not attend or is hospitalized, a reach -out call or visit is <br />made. <br />• Outreach provides an early warning system for members who are experiencing <br />difficulties. <br />• Through routine contact, a crisis, hospitalization or worse is often prevented. <br />• The Basic Components of Clubhouse: The Work Ordered Day <br />o Members and staff work together as colleagues to carry out all the critical work <br />necessary to sustain Clubhouse functions. <br />Agency Information 2/9/2017 1:51:06 PM Page 4 of 26 <br />