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DocuSign Envelope ID: C5305795- 2DF5- 4A04- B090- 9F458AA520CB <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br />Program Name: Charles House: Daytime Eldercare Program <br />Program Primary Contact and Title: Paul Klever, Executive Director <br />Telephone Number: 919 -967 -7570 E -Mail: paul (_)charleshouse.org <br />a) Indicate the type of Human Service Needs Priority, if program applicable: <br />® 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 />Z 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 />X <br />X <br />Education <br />Family Resources <br />X <br />X <br />Jobs /Jobs Training <br />Food <br />Transportation <br />Other: Please specify <br />–Daytime Eldercare <br />X <br />X <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 />• Orange County: Department on Aging — collaboration on various projects, including the <br />Master Aging Plan, the Aging -in- Community series, sharing referrals for aging <br />transitions, long -term care collaborative, contractually serve Orange County <br />families/caregivers. <br />• Orange County: Department of Social Services --- collaboration on contractually serving <br />Orange County families/caregivers, as well as with Adult Protective Services and <br />regulatory oversite done by DSS. <br />• UNC- Chapel Hill — collaborations with many of the schools and academic <br />departments /programs on opportunities for service learning for students /interns. <br />• UNC Health Care — collaboration on clinical initiatives, volunteers and Charles House <br />leadership <br />• Duke University — collaboration with the Fuqua Business School and other <br />departments /programs for service learning and Duke Family Support Program. <br />• Central Carolina University — collaboration with the school of social work. <br />• Durham Technical — collaboration with the occupational therapy assistant program <br />• Watts School of Nursing — collaboration on service learning <br />PROGRAM INFORMATION 1/22/2018 2:17:04 PM Page 7 of 15 <br />