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DocuSign Envelope ID: E8DFACF7 -45BE- 435E- 9B5A- BB177E968F07 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />located in (Hillsborough. Additional sites will include any school in the districts serving student <br />in Orange County as well as administrative offices of those districts and other gathering places <br />which will accommodate the provision of services requested. <br />(h) Describe period: <br />Camp ReLEAF is an annual event and is next scheduled for April 28 — 30, 2017. It will be held <br />at Camp New Hope. This schedule is followed as closely as possible each year after adjusting <br />for holidays or religious events which may interfere with those periods of time. <br />During the school year school based grief support groups are located at the requesting school site <br />and will run for a total of 6 weeks. The frequency will be detennined by the number of requests <br />received. <br />Individual, group and family grief support is provided as needed and according to mutual <br />developed goals established between the requesting person and the Duke Hospice Bereavement <br />staff. <br />Crisis intervention is available as requested. <br />School consultation is available upon request throughout the year. <br />(i) Why is funding a good investment? <br />• Death touches the lives of young people far more frequently than most of us would like to <br />admit. <br />• US Census Bureau stats — 5% by 16; 11% by 20 <br />90% of HS Students say they have experienced the death of a significant person in <br />their life <br />• 40% will experience the death of a peer. 20% will have witnessed a death. <br />• Impact is widespread and not contained to a specific period of time. Grief is a multi- <br />dimensional experience Developmental in nature — change in understanding and <br />experience. <br />Impacts learning, behavior, and development. Our work supports school personnel are in <br />a unique position to interact with children who are challenged to meet educational <br />objectives while trying to negotiate the very difficult emotional terrain in adjusting to the <br />death of a family member or friend. <br />• Many feel unprepared to respond to the needs of grieving students. The 2012 Study by <br />AFT and NY Life revealed: <br />