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DocuSign Envelope ID: A0992361- 7662- 4FD7- 9DB3- 9D760E06A5D2 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />1. COVER PAGE <br />a) Applicant Contact Information <br />Applicant Organization's Legal Name: OE Enterprises, Inc. <br />Applicant Organization's Physical Address: 348 Elizabeth Brady Rd. <br />Hillsborouah, NC 27278 <br />Applicant Organization's Mailing Address: 348 Elizabeth Brady Rd. <br />Hillsborough, NC 27278 <br />Applicant Organization's Web Address: www.oeenterprises.org <br />Executive Director: Margaret Samuels <br />Telephone Number: 919 - 732 -8124 <br />Tax ID Number: 57- 0740781 <br />E -Mail: samuelsm(a)oeenterprises.org <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 />Proqram <br />Carrboro <br />Chapel <br />Orange <br />Total <br />- HS <br />Hill - HS <br />County -HS <br />Transitions to Employment <br />$4,000 <br />$10,000 <br />$54,550 <br />$68,550 <br />Proposed use of funds: Personnel costs <br />associate with providing vocational <br />placement, training, and community <br />integration supports for students and adults <br />who have disabilities. <br />Totals <br />$4,000 <br />$10,000 <br />$54,550 <br />$68,550 <br />c) To the best of my knowledge and belief all information and data in this application is <br />true and current. The document has been duly authorized by the governing board of the <br />applicant. <br />-Na <br />Signature: <br />Executive Director <br />Date <br />Signature: a'- v (3qw�� <br />Board Chairperson V Date <br />AGENCY INFORMATION 1/22/2018 1:53 :42 PM <br />1/22/18 <br />1/22/18 <br />Page 2 of 18 <br />