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DocuSign Envelope ID: E30588DE -A1 BC- 443D- A5C4- 3BE790331500 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br />Program Name: Adapted Sport Programing <br />Program Primary Contact and Title: Ashley Thomas, Founder & Executive Director <br />Telephone Number: (866) 880 -2742 <br />E-mail: ashle brid e2s orts.or <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. Housirlg <br />Neigh borhoodslResidents <br />Affordable Housing <br />Affordable Healthcare <br />Education <br />X <br />X <br />X <br />Family Resources <br />X <br />X <br />X <br />X <br />Jobs /Jobs Training <br />X <br />X <br />X <br />Food <br />Transportation <br />Other: Please specify <br />Health & Fitness <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 />• Chapel Hill Parks and Recreation — We collaborate to use the Chapel Hill <br />Community Center for practices, clinics, trainings and competitions. <br />• UNC Chapel Hill — We accomplish programming, volunteer opportunities and <br />hands -on learning skills for UNC students and faculty members. <br />• Disabled Sports USA — As a member of DSUSA, we have low -cost insurance <br />that is required to safely execute program objectives for athletes, volunteers <br />and supporters. <br />• Chapel Hill /Carrboro local businesses and organizations — Donate raffle and <br />auction items. <br />• Chapel Hill Chamber of Commerce — Work together to network and promote <br />BI IS services for sponsorship engagement. <br />Agency Information 1/22/2018 10:12:15 AM Page 12 of 30 <br />