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MAIN APPLICATION <br />3. PROJECT /PROGRAM INFORMATION <br />Agency & Program Name: Piedmont Health Services, Inc. /Carrboro Community Health Center Program). <br />As you complete your application, complete only those sections that pertain to the type of <br />application you are submitting. The application is divided into several sections and not all sections <br />apply to every project. Every applicant MUST complete the main application. <br />a) Check the type of funding request for this application package submittal and complete the <br />required application and required supplemental sections (Parts) as specified below: <br />® Human Services (Main Application Only) <br />❑ CDBG Non - Construction — (Main Application AND Part A) <br />❑ CDBG Construction — (Main Application AND Part A AND Part B) <br />❑ HOME CHDO Set -aside — (Main Application AND Part A) <br />❑ HOME Other — (Main Application AND Part A AND Part B) <br />Indicate the type of program for which you are requesting funding: <br />Program Category <br />Youth <br />Adult <br />Elderly <br />Disabled <br />(not elderly) <br />Public Housing <br />Neighborhoods /Residents <br />Education <br />Health and Nutrition <br />X <br />X <br />X <br />X <br />X <br />Job Training <br />Sports and Arts <br />Activities <br />Pre - School Activities <br />After - School <br />Activities <br />Mentorin <br />Transportation <br />Housing <br />Other: Please <br />specify <br />Program /Project Description (Label your responses as outlined below; not to exceed 3 pages.) <br />Please provide the following information about the proposed program /project: <br />b) Summarize the program services proposed and how the program will address the chosen <br />Town /County priority? <br />PHS is requesting on -going support of its Carrboro Community Health Center (CCHC) Program (with <br />human services funds generally directed to support sliding -fee primary medical services for the low- income, <br />uninsured population at the Center (i.e those living below 200% of poverty)). As summarized in the table in <br />Section 2, the CCHC program model provides "one -stop shop access" to comprehensive services for people <br />Revised November 20, 2014 <br />Page 6 of 22 Pages <br />