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DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />2. AGENCY INFORMATION (Be Very Brief and Concise) <br />Please provide the following information about your agency (2 pages OR LESS): <br />a) Years in Operation, Date of Incorporation (Month/Year): 78 years in operation; <br />incorporated in 1942 <br />b) Agency's Purpose /Mission (no more than a few sentences): <br />Mission: The Boys & Girls Clubs of Durham and Orange Counties mission is to inspire and <br />enable all young people, particularly those who need us most, to reach their full potential as <br />productive, caring and responsible citizens. <br />Purpose: To instill a sense of competence, a sense of belonging and a sense of having <br />power and influence, especially over their own lives as well as in the community. <br />c) Types of Services the Agency Provides (bullet format): <br />• Assistance with homework with goal of academic success and graduation from high school <br />• Character and leadership development through volunteer programs, healthy interaction with <br />peers and adults, and opportunities to get involved in the community <br />• Health education (both mental and physical) that incorporates age - appropriate lessons to <br />ensure that Club members develop the capacity to engage in positive behaviors and set <br />goals. Programs include: Smart Moves, Healthy Habits, Smart Girls, and Passport to <br />Manhood <br />• Summer camp that helps children continue to engage in educational activities throughout the <br />summer, decreasing the educational gap between spring and fall <br />• Exposure to various opportunities that allow members to explore career paths, the arts, the <br />environment and technology <br />d) Agency's History with Providing These Services: <br />The Durham and Chapel Hill Clubs have been successfully operating for 78 years and the Chapel <br />Hill Impact Program has been successfully operating for 4 years. <br />e) Other Pertinent Agency Information (Ex. Has the agency experienced any major changes <br />in the past year? Is there a new Executive Director? Are there new initiatives ?) <br />After the merger, the name Boys & Girls Clubs of Durham and Orange Counties has been legally <br />changed. A new Board Chair was also recently appointed; Lynda Curtis now serves as the Chair. <br />f) Schedule of Positions (For Entire Agency) <br />• Full Time Equivalent (FTE) staff will be noted as 1.00; half-time as .50; quarter time as .25, etc. <br />• Calculate a Full Time Equivalent for all recorded volunteer hours using the following: <br />Total Volunteer Hours = VVolunIter FTE <br />2,080 <br /># of FTE - Full Time Paid Positions: 4 <br /># of FTE - Paid Part Time Positions: 6.5 <br />