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3. Program Information <br />a. <br />❑ Human Services Needs Priority <br />b. <br />❑Type of Program <br />Afterschool Program <br />c. <br />❑Agency Collaboration <br />d. <br />❑Summary of Program <br />e. <br />❑Description of Identified Need <br />f. <br />❑Description of Population to be Served <br />g. <br />❑Program Staffing, Capacity, & Expertise <br />h. <br />❑Program Implementation Timeline <br />L <br />❑Value of Investment <br />j. <br />❑Impact of Reduced /No Allocation <br />k. <br />❑Other Pertinent Information <br />I. <br />❑Target Population /Beneficiary Chart <br />m. <br />❑Work Statement <br />n. <br />❑Program Budget, Detail, & Cost per Individual <br />3A. Program Information <br />o. <br />❑Human Services Needs Priority <br />p. <br />❑Type of Program <br />Day Camp Program. <br />q. <br />❑Agency Collaboration <br />r. <br />❑Summary of Program <br />s. <br />❑Description of Identified Need <br />t. <br />❑Description of Population to be Served <br />u. <br />❑Program Staffing, Capacity, & Expertise <br />v. <br />❑Program Implementation Timeline <br />w. <br />❑Value of Investment <br />x. <br />❑Impact of Reduced /No Allocation <br />y. <br />❑Other Pertinent Information <br />z. <br />❑Target Population /Beneficiary Chart <br />aa. <br />❑Work Statement <br />bb. ❑Program Budget, Detail, & Cost per Individual <br />4. Attachments <br />a. <br />❑Audit: Organizations receiving $300,000 or more in Federal <br />financial assistance, and /or organizations with more than $500,000 <br />of receipts and expenditures in a fiscal year, must secure an audit. <br />b. <br />❑IRS Federal Form 990 <br />c. <br />❑NC Solicitation License <br />d. <br />❑IRS Federal Tax - Exemption Letter <br />e. <br />❑Certificate of Insurance <br />f. <br />❑List of Board of Directors <br />g. <br />❑Solid Waste Program Fee (SWPF) Verification <br />1/12/2017 2:56:42 PM 3 Of 29 <br />