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DocuSign Envelope ID: 07FEE1A8- E83F- 44CF- 99C4- 61A6E4C39BD2 <br />EXHIBIT A - PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Human Services — Town Of Chapel Hill <br />In 1982, the Town established local funding to support local nonprofit organizations that <br />carry out human service work throughout the community. <br />Applications are accepted once a year and reviewed by the Town's Human Services <br />Advisory Board, which makes a recommendation for funding to the Town Council for final <br />approval. <br />For more information about the Town of Chapel Hill Human Services program, see here. <br />Questions and submittals should be directed to: <br />Jackie Thompson <br />405 Martin Luther King Jr. Blvd. <br />Chapel Hill, NC 27514 <br />919- 969 -5081 <br />jhompson(c�townofchapelhill.org <br />Submission: <br />➢ We strongly encourage applications to be single- spaced, with 12 -point arial <br />font and normal margins. <br />Application: Two (2) paper copies of the application with ORIGINAL <br />signatures must be hand delivered or mailed to Jackie Thompson, 405 <br />Martin Luther King, Jr. Blvd., Chapel Hill, NC 27514; AND <br />Attachments: The application submittal must be accompanied by a flash drive <br />with the application and all attachment files in electronic format. Any .pdf <br />files must be accompanied by the original file format of .doc, .xls, etc. <br />Human Services— Orange County <br />For more information about the Orange County Human Services program, see here. <br />Questions and submittals should be directed to: <br />Allen Coleman <br />PO Box 8181 <br />Hillsborough, NC 27278 <br />(919) 245 -2151 <br />acoleman(o)_orangecountync.gov <br />Submission: <br />Email application and ALL Attachments prior to the deadline. Any .pdf <br />files must be accompanied by the original file format of .doc, .xIs, etc. Please <br />request a delivery receipt of email with application and attachments. <br />DO NOT SUBMIT THIS PAGE 2/9/2017 4:31:06 PM Page 4 of 22 <br />