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DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br />Program Name: Agency Administration: Rent, Utilities, Insurance <br />Program Primary Contact and Title: Flicka Bateman <br />Telephone Number: (919) 423 -1478 <br />E -Mail: fbatemanrsc(o-)gmail.com <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 />® 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 />X <br />X <br />X <br />x <br />X <br />Affordable Healthcare <br />X <br />X <br />x <br />x <br />X <br />Education <br />X <br />X <br />x <br />x <br />X <br />Family Resources <br />x <br />x <br />x <br />x <br />X <br />Jobs /Jobs Training <br />X <br />x <br />X <br />Food <br />X <br />X <br />x <br />x <br />X <br />Transportation <br />x <br />x <br />x <br />x <br />X <br />Other: Immigration <br />Legal Services <br />X <br />X <br />x <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 Literacy: This agency provides funding for teacher and materials for <br />on -site citizenship class <br />• Family Reading Partners: Agency volunteers schedule "story time" sessions <br />on site for refugee parents and children whom we recruit and arrange <br />interpreters for. <br />• Carrboro Community Health Clinic: The clinic refers clients to our services <br />and we assist clients with making medical appointments and medication <br />refills. <br />• Orange County Departments of Health and Social Services: We make <br />appointments, collaborate on completing immunization records for green card <br />applications, and refer clients when they move from out of state. Receive <br />referrals for immigration legal services. <br />PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 16 of 26 <br />