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DocuSign Envelope ID: 74839431 - 9216- 429F- BFA4- 2AC6473BD9D3 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />3. PROGRAM INFORMATION (Submit a separate Section 3 for each <br />Program Name: Partner Abuse Intervention <br />Program Primary Contact and Title: Kathrvn Bauman Executive Director <br />ram) <br />Telephone Number: (919)145-3309 E -Mail: khauman @pathwaystochangenc.org <br />a) Indicate the type of Human Service bleeds Priority, if program applicable: <br />0 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 />FAdult <br />Elderly <br />Disabled <br />Public Housing <br />i <br />Neighborhoods /Residents <br />Affordable Housing <br />Affordable Healthcare <br />Education <br />X <br />X <br />X <br />X <br />Family Resources <br />Jobs /Jobs Training <br />Food <br />Transportation <br />Other: Please specify <br />c) Provide a buileted 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 />• Department of Social Services — Our staff provides presentations and <br />liaises with DSS staff to enroll participants, monitor their progress, and <br />support their case management needs <br />• Courts /Probation /Parole — We liaise with court personnel and community <br />corrections staff to receive referrals and provide /receive updates <br />regarding participant progress <br />• The Compass Center — We maintain a formal Memorandum of <br />Understanding to ensure that victims of those participating in Partner <br />Abuse Intervention Program are connected with therapeutic and <br />supportive services <br />PROGRAM INFORMATION 1123/2018 11:18:32 AM Page ! A o f 30 <br />