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DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />1. OVER PAGE <br />a) Applicant_ Contact Information <br />Applicant Organization's Legal Name: Voices Together <br />Applicant Organization's Physical Address: 5007 Southpark Drive Ste 230 Durham, NC 27713 <br />Applicant Organization's Mailing Address: 5007 Southpark Dave Ste 230 Durham NC 27713 <br />Applicant Organization's Web Address: www.voicestogether.net <br />E=xecutive Director: Yasmine White <br />Telephone Number: 919- 942 -2714 <br />Tax ID Number: 20- 4612388 <br />E -Mail: jeanne@voicestogether.net <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 />Program <br />Carrboro <br />Chapel <br />Hill - HS <br />Orange <br />County-HS <br />Total <br />- HS <br />Ex. Youth Afterschool Program <br />Afierschool Program Coordinator salary and materials <br />for youth activities and projects <br />$10,000 <br />$15,000 <br />$5,000 <br />$30,000 <br />VT in Education program in four OC Exceptional Child <br />classrooms; covers board - certified Music Therapist <br />and class materials and equipment <br />$20,000 <br />$20,000 <br />Totals <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 />Signatulrw--- <br />,_ Fx cutive director Date <br />Signature: Board Chairp rson Date,�r <br />AGENCY INFORMATION 1/22/2018 12:53:10 PM Page 8 of 25 <br />