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DocuSign Envelope ID: 1640431D- 872F- 4BC9- ACA1- 2226D9788920 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />1. COVER PAGE <br />a) Applicant Contact Information <br />Applicant Organization's Legal Name: Orange County Partnership for Young Children <br />Applicant Organization's Physical Address: 120 Providence Road, Suite 101, Chapel Hill, NC <br />27514 <br />Applicant Organization's Mailing Address: 120 Providence Road, Suite 101, Chapel Hill, NC <br />27514 <br />Applicant Organization's Web Address: www.orangesma_ rtstart.org <br />Executive Director: Robin Pulver <br />Telephone Number: 919 - 967 -9091 E -Mail: rpulver@orangesmartstart.org <br />Tax ID Number: 56- 1844192 <br />b) Funding Request <br />List all FY18 -19 Human Services (HS) Funding Being Requested — <br />For All Programs) and the Proposed Use of Funds (2 -3 lines or less) <br />Proeram <br />Carrboro <br />Chapel <br />Hill - HS <br />Orange <br />Coun -HS <br />Total <br />- HS <br />Ex Youth Afterschool Program <br />Afterschool Program Coordinator salary and materials <br />for youth activities and projects <br />$10,000 <br />$15.000 <br />$5,000 <br />$30.000 <br />Transplanting Traditions Community Farm <br />Staffing, contractual services, and materials to support <br />the activities of Transplanting Traditions Community <br />Farm, a community farm for refugees from Burma. <br />Contracted services include a native translator from <br />Burma. <br />$7,000 <br />$7,000 <br />$7,000 <br />$21,000 <br />Totals <br />$7,000 <br />$7,000 <br />$7,000 <br />$21,000 <br />AGENCY INFORMATION 1/22/2018 6:18:22 PM Page 3 of 22 <br />