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2018-472-E Finance - Pathways to Change outside agency agreement
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2018-472-E Finance - Pathways to Change outside agency agreement
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Last modified
7/25/2019 12:43:36 PM
Creation date
8/27/2018 9:14:27 AM
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Contract
Date
7/1/2018
Contract Starting Date
7/1/2018
Contract Ending Date
6/30/2019
Contract Document Type
Agreement - Performance
Amount
$7,000.00
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R 2018-472 Finance - Pathways to Change outside agency agreement
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\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2018
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DocuSign Envelope ID: 74839431 - 9216- 429F- BFA4- 2AC6473BD9D3 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Additional Pro ram Information Partner Abuse Intervention <br />n) Target Population <br />Complete the following tables, with numbers (not percentages) of individuals served and to be <br />served, to the best of your ability, <br />rogram Target Population Qemograph <br />Gender <br />Male <br />Female <br />Total <br />Ethnicity <br />African - American <br />American Indian or Alaska Native <br />Asian <br />Caucasian <br />Native Hawaiian or other Pacific Islander <br />Other: specify <br />Total <br />Of the above, how many Hispanic/Latino <br />Of the above, how many non-Hispanic/Latino <br />Total <br />Age <br />Geographic Location <br />0 -5 years <br />6 -18 years <br />19 -50 years <br />51 # years <br />Total <br />Actual Estimated Projected <br />2016 -17 2017 -18 2018 -19 <br />3 <br />44 <br />44 <br />0 <br />0 <br />40 <br />3 <br />44 <br />44 <br />2 <br />16 <br />16 <br />2 <br />40 <br />40 <br />3 <br />44 <br />44 <br />1 <br />28 <br />28 <br />3 <br />44 <br />44 <br />5 <br />1 5 <br />3 <br />44 <br />44 <br />1 <br />4 <br />4 <br />2 <br />40 <br />40 <br />3 <br />44 <br />44 <br />Alarnance County <br />Chatham County 1 11 <br />Durham County 1 10 <br />Wake County <br />Orange County Breakdown <br />Chapel Hill Public Housing <br />Town of Chapel Hill (Non- Public Housing) <br />Town of Carrboro <br />Town of Hillsborough <br />City of Mebane (Orange County) <br />Orange County (Outside Municipalities) <br />1 <br />11 <br />11 <br />3 <br />35 <br />35 <br />9 <br />9 <br />3 <br />44 <br />44 <br />Alarnance County <br />Chatham County 1 11 <br />Durham County 1 10 <br />Wake County <br />Orange County Breakdown <br />Chapel Hill Public Housing <br />Town of Chapel Hill (Non- Public Housing) <br />Town of Carrboro <br />Town of Hillsborough <br />City of Mebane (Orange County) <br />Orange County (Outside Municipalities) <br />Total 1 3 1 44 44 <br />PROGRAM INFORMATION 1/23/2018 11:18:32 AM Page 18 of 30 <br />1 <br />11 <br />11 <br />2 <br />2 <br />2 <br />2 <br />3 <br />3 <br />5 <br />1 5 <br />Total 1 3 1 44 44 <br />PROGRAM INFORMATION 1/23/2018 11:18:32 AM Page 18 of 30 <br />
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