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DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br />Program Name: Meals for the Elderly and Homebound <br />Program Primary Contact and Title: Rachel Sobel Bearman, Executive Director <br />Telephone Number: 919 - 942 -2948 E -Mail: Rachel.bearman @chcmow.org <br />a) Indicate the type of Human Service Needs Priority, if program applicable: <br />X Priority Area #1: safety -net services for disadvantaged residents <br />❑ Priority Area #2: education, mentorship, and afterschool programming for <br />youth facing a variety of challenges <br />X Priority Area #3: programs aimed at improving health and nutrition of needy residents <br />b) Indicate the type of program for which you are requesting funding <br />(Check all that apply to this program) <br />Program Category <br />Youth <br />Adult <br />Elderly <br />Disabled <br />Public Housing <br />Neighborhoods /Residents <br />Affordable Housing <br />Affordable Healthcare <br />Education <br />Family Resources <br />Jobs /Jobs Training <br />Food <br />X <br />X <br />X <br />X <br />Transportation <br />Other: Please specify <br />c) Provide a bulleted list of other agencies, if any, with which your agency <br />coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) <br />to be funded. For each, briefly describe the coordinated /collaborative efforts. <br />Provide a bulleted list of other agencies, <br />• OCRA, Orange County Rural Alliance — information and process sharing; joint shelf - stable <br />meal purchasing, joint administrative tasks such as volunteer verification, etc. <br />• Arc of Orange County, RSI, CHCCS special needs programs — we provide volunteer <br />placements for those with challenges. They help set up, count out meals, and deliver. <br />• Porch — partner to deliver monthly senior snack bags which are shelf stable and augment <br />the clients' pantries <br />• Inter Faith Council (IFC) — we refer clients who may be eligible for additional services <br />(vision care, Sec 8 housing challenges) <br />• Farmer Foodshare — we purchase fruit on Tuesday in the spring and summer months <br />• Book Harvest NC — deliver books that are like new (they serve children, so we take <br />donations that are suitable for adults) <br />PROGRAM INFORMATION 1/22/2018 9:22:00 AM Page 15 of 26 <br />